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General NPI Number Information
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NPI Number | 1861828212
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Entity Type | Organization
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Legal Business Name | VISCITO FAMILY MEDICINE, PLLC
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 01/07/2014
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Provider Practice Location Address
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Address Line | 2750 S 26TH ST SUITE C
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City | GRAND FORKS
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State | ND
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Zip | 58201-6432
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Country | US
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Telephone | 701-757-1999
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Fax | 701-757-0898
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Provider Business Mailing Address
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Address Line | 2750 S 26TH ST SUITE C
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City | GRAND FORKS
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State | ND
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Zip | 58201-6432
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Country | US
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Telephone | 701-757-1999
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Fax | 701-757-0898
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Authorized Official
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Title or Position | PROPRIETOR
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Name | DR. MATTHEW STEPHEN VISCITO
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Credential | M.D.
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Telephone | 701-757-1999
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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 | 10982
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License Number State | ND
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