Provider Demographics
NPI:1093764599
Name:MEDICAL ARTS OUTPATIENT SERVICES, INC.
Entity Type:Organization
Organization Name:MEDICAL ARTS OUTPATIENT SERVICES, INC.
Other - Org Name:KEYCARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-857-5000
Mailing Address - Street 1:400 BURDICK EXPY E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4768
Mailing Address - Country:US
Mailing Address - Phone:701-857-7900
Mailing Address - Fax:701-857-7834
Practice Address - Street 1:400 BURDICK EXPY E
Practice Address - Street 2:SUITE 201
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4768
Practice Address - Country:US
Practice Address - Phone:701-857-7900
Practice Address - Fax:701-857-7834
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-10
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X
ND223336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1454946Medicaid
ND30751OtherBLUE CROSS BLUE SHIELD
ND20121Medicaid
ND3501384OtherNABP