Provider Demographics
NPI:1063686640
Name:CITY OF FARGO
Entity Type:Organization
Organization Name:CITY OF FARGO
Other - Org Name:FARGO CASS PUBLIC HEALTH IMMUNIZATIONS
Other - Org Type:Other Name
Authorized Official - Title/Position:ACCOUTANT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-241-1392
Mailing Address - Street 1:401 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4811
Mailing Address - Country:US
Mailing Address - Phone:701-241-1392
Mailing Address - Fax:
Practice Address - Street 1:401 3RD AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4811
Practice Address - Country:US
Practice Address - Phone:701-241-1392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare