Provider Demographics
NPI:1083625354
Name:THREE AFFILIATED TRIBES KIDNEY DIALYSIS UNIT
Entity Type:Organization
Organization Name:THREE AFFILIATED TRIBES KIDNEY DIALYSIS UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LONE BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-627-4840
Mailing Address - Street 1:1058 COLLEGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763-9112
Mailing Address - Country:US
Mailing Address - Phone:701-627-4840
Mailing Address - Fax:701-627-4842
Practice Address - Street 1:1058 COLLEGE DR STE B
Practice Address - Street 2:
Practice Address - City:NEW TOWN
Practice Address - State:ND
Practice Address - Zip Code:58763-9112
Practice Address - Country:US
Practice Address - Phone:701-627-4840
Practice Address - Fax:701-627-4842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND01323Medicaid
ND57787OtherMEDICAID TRANSPORTATION
ND09613OtherBLUE CROSS BLUE SHIELD
ND01323Medicaid