Provider Demographics
NPI:1235274697
Name:HIRT, ELIZABETH (PAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HIRT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:218-732-2800
Mailing Address - Fax:218-732-2874
Practice Address - Street 1:705 PLEASANT AVE S
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1440
Practice Address - Country:US
Practice Address - Phone:218-732-2800
Practice Address - Fax:218-732-2874
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10244363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN524118000Medicaid
MN564L1HIOtherMNBS #
MN27971OtherNDBS #
MN564L2HIOtherMNBS #
MN00059882OtherLHS-BANNER HEALTH #
MNHP77231OtherHEALTHPARTNERS #
MN1235274697Medicaid
MN138859OtherUCARE #
MN564L0HIOtherMNBS #
MN564L0HIOtherMNBS #
MN564L2HIOtherMNBS #
MN970002906Medicare ID - Type UnspecifiedMN MEDICARE 3
MN970003238Medicare PIN
MN27971OtherNDBS #
MN00059882OtherLHS-BANNER HEALTH #