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General NPI Number Information
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NPI Number | 1346299336
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Entity Type | Organization
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Legal Business Name | MEDCENTER ONE INC.
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 512 N 7TH ST
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City | BISMARCK
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State | ND
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Zip | 58501-4425
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Country | US
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Telephone | 701-323-6276
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Fax |
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Provider Business Mailing Address
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Address Line | 5654 FALCONER DR
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City | BISMARCK
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State | ND
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Zip | 58504-3179
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Country | US
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Telephone | 701-323-6276
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Fax |
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Authorized Official
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Title or Position | NP
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Name | MRS. SHIH-RU MARTIN
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Credential | MSN, FNP
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Telephone | 701-323-6276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | R27183
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License Number State | ND
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