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General NPI Number Information
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NPI Number | 1578594016
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Entity Type | Organization
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Legal Business Name | REGIONAL MEDICAL CENTER PC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 08/14/2009
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Provider Practice Location Address
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Address Line | 2008 TWIN CITY DR
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City | MANDAN
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State | ND
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Zip | 58554-3820
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Country | US
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Telephone | 701-667-1000
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Fax | 701-667-0707
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Provider Business Mailing Address
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Address Line | 2008 TWIN CITY DR
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City | MANDAN
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State | ND
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Zip | 58554-3820
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Country | US
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Telephone | 701-667-1000
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Fax | 701-667-0707
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | VICKI L BOEHM
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Credential |
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Telephone | 701-667-1022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4124
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License Number State | ND
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