MEDICARE: REGIONAL MEDICAL CENTER 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	207Q00000X	Family Medicine Physician	4124	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1051140001	OTHER	ND	DMERC CIGNA
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	C52498	OTHER	ND	PALMETTO GBA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578594016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REGIONAL MEDICAL CENTER PC

Provider Business Mailing Address
First Line	:	2008 TWIN CITY DR
Second Line	:
City	:	MANDAN
State	:	ND
Zip	:	58554-3820
Country	:	US
Telephone Number	:	701-667-1000
Fax Number	:	701-667-0707

Provider Business Practice Location Address
First Line	:	2008 TWIN CITY DR
Second Line	:
City	:	MANDAN
State	:	ND
Zip	:	58554-3820
Country	:	US
Telephone Number	:	701-667-1000
Fax Number	:	701-667-0707

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	VICKI L BOEHM
Credential	:
Telephone Number	:	701-667-1022

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/14/2009

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Directions to “REGIONAL MEDICAL CENTER PC ” Practice Location

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