Provider Demographics
NPI:1326144221
Name:FM ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:FM ENDOSCOPY CENTER LLC
Other - Org Name:CENTER FOR SPECIAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JED
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:LAPLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:701-356-4770
Mailing Address - Street 1:350 23RD AVE EAST, SUITE 201
Mailing Address - Street 2:
Mailing Address - City:WEST FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58078
Mailing Address - Country:US
Mailing Address - Phone:701-356-4770
Mailing Address - Fax:701-356-4774
Practice Address - Street 1:350 23RD AVE EAST, SUITE 201
Practice Address - Street 2:
Practice Address - City:WEST FARGO
Practice Address - State:ND
Practice Address - Zip Code:58078
Practice Address - Country:US
Practice Address - Phone:701-356-4770
Practice Address - Fax:701-356-4774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1465089Medicaid
ND1465089Medicaid
=========OtherCOMMERCIAL INS
NDN711405Medicare PIN
106919OtherHEALTH PARTNERS
NDN711356Medicare ID - Type Unspecified
ND06509001OtherND BLUE SHIELD
ND25389OtherND BLUE SHIELD