Provider Demographics
NPI:1225083140
Name:WINMAR DIAGNOSTICS NORTH CENTRAL
Entity Type:Organization
Organization Name:WINMAR DIAGNOSTICS NORTH CENTRAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-235-7424
Mailing Address - Street 1:2700 12TH AVE S
Mailing Address - Street 2:STE B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8723
Mailing Address - Country:US
Mailing Address - Phone:701-235-7424
Mailing Address - Fax:701-239-4792
Practice Address - Street 1:24 E 7TH ST
Practice Address - Street 2:STE 100
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1312
Practice Address - Country:US
Practice Address - Phone:320-208-1879
Practice Address - Fax:701-239-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory