Provider Demographics
NPI:1124032487
Name:REGIONAL NEUROLOGICAL CENTER PC
Entity Type:Organization
Organization Name:REGIONAL NEUROLOGICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAGLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-222-1300
Mailing Address - Street 1:1033 BASIN AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6649
Mailing Address - Country:US
Mailing Address - Phone:701-222-1300
Mailing Address - Fax:701-222-2166
Practice Address - Street 1:1033 BASIN AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6649
Practice Address - Country:US
Practice Address - Phone:701-222-1300
Practice Address - Fax:701-222-2166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5499261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty