Provider Demographics
NPI:1205184256
Name:MEDICAL ARTS OUTPATIENT SERVICES, INC.
Entity Type:Organization
Organization Name:MEDICAL ARTS OUTPATIENT SERVICES, INC.
Other - Org Name:KEYCARE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-857-5000
Mailing Address - Street 1:530 20TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6437
Mailing Address - Country:US
Mailing Address - Phone:701-857-7425
Mailing Address - Fax:701-857-7419
Practice Address - Street 1:400 BURDICK EXPY E
Practice Address - Street 2:SUITE #E117
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4768
Practice Address - Country:US
Practice Address - Phone:701-857-7370
Practice Address - Fax:701-857-7419
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRINITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-23
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND02385800332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1460634Medicaid