Provider Demographics
NPI:1275898678
Name:PRACS INSTITUTE MANAGEMENT, LLC
Entity Type:Organization
Organization Name:PRACS INSTITUTE MANAGEMENT, LLC
Other - Org Name:PRACS INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, MARKETING
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLONINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-478-0150
Mailing Address - Street 1:4801 AMBER VALLEY PKWY S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8623
Mailing Address - Country:US
Mailing Address - Phone:701-239-4750
Mailing Address - Fax:
Practice Address - Street 1:4801 AMBER VALLEY PKWY S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8623
Practice Address - Country:US
Practice Address - Phone:701-239-4750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory