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General NPI Number Information
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NPI Number | 1952331159
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL CLINIC PC
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Dates
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Enumeration Date | 07/04/2006
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Last Update Date | 07/31/2007
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Provider Practice Location Address
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Address Line | 10 9TH AVE E
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City | LISBON
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State | ND
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Zip | 58054
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Country | US
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Telephone | 701-683-4711
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Fax | 701-683-3205
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Provider Business Mailing Address
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Address Line | 10 9TH AVE E PO BOX 1049
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City | LISBON
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State | ND
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Zip | 58054
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Country | US
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Telephone | 701-683-4711
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Fax | 701-683-3205
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BARBARA SHEETS OLSON
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Credential | MD
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Telephone | 701-683-4711
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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 | 4909
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License Number State | ND
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