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General NPI Number Information
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NPI Number | 1831137389
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Entity Type | Organization
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Legal Business Name | RICHARD P STADTER PSYCHIATRIC CENTER, LLC
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 06/24/2015
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Provider Practice Location Address
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Address Line | 1451 44TH AVE S STE A
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City | GRAND FORKS
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State | ND
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Zip | 58201-3434
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Country | US
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Telephone | 701-772-2500
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Fax | 701-787-8996
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Provider Business Mailing Address
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Address Line | 1451 44TH AVE S PO BOX 14354
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City | GRAND FORKS
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State | ND
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Zip | 58201-3434
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Country | US
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Telephone | 701-772-2500
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Fax | 701-732-2685
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Authorized Official
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Title or Position | PRESIDENT/ CHIEF MEDICAL OFFICER
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Name | DR. THOMAS PETERSON
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Credential | MD
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Telephone | 701-772-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number | 5066A
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License Number State | ND
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