Provider Demographics
NPI:1326818188
Name:CONNECT MEDICAL CLINIC
Entity Type:Organization
Organization Name:CONNECT MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZETTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-483-9353
Mailing Address - Street 1:683 STATE AVE STE E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4660
Mailing Address - Country:US
Mailing Address - Phone:701-483-9353
Mailing Address - Fax:701-483-5961
Practice Address - Street 1:683 STATE AVE STE E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4660
Practice Address - Country:US
Practice Address - Phone:701-483-9353
Practice Address - Fax:701-483-5961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty