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General NPI Number Information
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NPI Number | 1811162811
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Entity Type | Organization
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Legal Business Name | FAIRLIGHT MEDICAL CENTER
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Dates
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Enumeration Date | 04/30/2008
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 3 4TH ST E
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City | WILLISTON
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State | ND
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Zip | 58801-5350
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Country | US
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Telephone | 701-577-6337
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Fax | 701-577-4867
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Provider Business Mailing Address
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Address Line | 3 EAST 4TH STREET PO BOX 1148
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City | WILLISTON
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State | ND
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Zip | 58802-1148
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Country | US
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Telephone | 701-577-6337
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Fax | 701-577-4867
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. LESZEK J JASZCZAK
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Credential | MD
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Telephone | 701-577-6337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 6414
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License Number State | ND
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