Provider Demographics
NPI:1255301719
Name:ADVANCED ORTHOPEDICS OF ND PC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDICS OF ND PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOVACS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:701-456-3819
Mailing Address - Street 1:47 8TH ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3951
Mailing Address - Country:US
Mailing Address - Phone:701-456-3819
Mailing Address - Fax:701-456-3815
Practice Address - Street 1:47 8TH ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3951
Practice Address - Country:US
Practice Address - Phone:701-456-3819
Practice Address - Fax:701-456-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDCG0854OtherRAILROAD MEDICARE
ND18784Medicaid
ND698001OtherBLUE CROSS BLUE SHIELD
ND698001OtherBLUE CROSS BLUE SHIELD
ND1135030001Medicare NSC