MEDICARE: DAKOTA CLINIC, LTD.

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457302176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAKOTA CLINIC, LTD.

Provider Business Mailing Address
First Line	:	275 11TH ST S
Second Line	:
City	:	WAHPETON
State	:	ND
Zip	:	58075-4655
Country	:	US
Telephone Number	:	701-642-2000
Fax Number	:	701-671-4106

Provider Business Practice Location Address
First Line	:	501 MAIN AVE S
Second Line	:
City	:	HANKINSON
State	:	ND
Zip	:	58041-4108
Country	:	US
Telephone Number	:	701-242-7118
Fax Number	:	701-242-7028

Authorized Official
Title or Position	:	ADMINISTRATOR-AUTHORIZED OFFICIAL
Name	:	LARRY G SOLBERG
Credential	:
Telephone Number	:	701-364-3405

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	08/22/2020

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Directions to “DAKOTA CLINIC, LTD. ” Practice Location

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