Provider Demographics
NPI:1043389117
Name:FAMILY HEALTH CARE CENTER
Entity Type:Organization
Organization Name:FAMILY HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-239-2286
Mailing Address - Street 1:P.O. BOX 2625
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102
Mailing Address - Country:US
Mailing Address - Phone:701-271-3344
Mailing Address - Fax:701-271-3343
Practice Address - Street 1:901 8TH ST. S
Practice Address - Street 2:CONCORDIA HEALTH SERVICES
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560
Practice Address - Country:US
Practice Address - Phone:218-299-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN322883500Medicaid
ND05900Medicaid
241827Medicare PIN
ND05900Medicaid