MEDICARE: RED RIVER VALLEY HEALTH CARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1053870253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED RIVER VALLEY HEALTH CARE PC

Provider Business Mailing Address
First Line	:	3800 56TH AVE S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-6706
Country	:	US
Telephone Number	:	701-356-1500
Fax Number	:	701-356-1596

Provider Business Practice Location Address
First Line	:	3800 56TH AVE S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-6706
Country	:	US
Telephone Number	:	701-356-1500
Fax Number	:	701-356-1596

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	THERESA STAHL
Credential	:
Telephone Number	:	701-356-1507

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	04/23/2026

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