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General NPI Number Information
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NPI Number | 1356511661
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Entity Type | Organization
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Legal Business Name | MID DAKOTA CLINIC WORKLIFE
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Dates
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Enumeration Date | 03/04/2008
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Last Update Date | 10/25/2022
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Provider Practice Location Address
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Address Line | 401 N 9TH ST
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City | BISMARCK
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State | ND
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Zip | 58501-4530
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Country | US
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Telephone | 701-530-6010
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Fax | 701-530-6430
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Provider Business Mailing Address
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Address Line | 2700 STATE ST
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City | BISMARCK
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State | ND
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Zip | 58503-0669
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Country | US
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Telephone | 701-530-6400
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Fax | 701-530-6430
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. WILLIAM HEEGAARD
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Credential |
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Telephone | 701-364-4554
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number |
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License Number State |
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