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General NPI Number Information
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NPI Number | 1740254523
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Entity Type | Organization
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Legal Business Name | TIOGA MEDICAL CENTER
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | MAIN STREET
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City | POWERS LAKE
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State | ND
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Zip | 58773
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Country | US
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Telephone | 701-464-5668
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 159
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City | TIOGA
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State | ND
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Zip | 58852-0159
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Country | US
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Telephone | 701-664-3305
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Fax | 701-664-2240
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | RANDALL K. PEDERSON
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Credential |
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Telephone | 701-664-3305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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