Provider Demographics
NPI:1346468808
Name:SOUTHWESTERN DIST HEALTH UNIT
Entity Type:Organization
Organization Name:SOUTHWESTERN DIST HEALTH UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLOTTA
Authorized Official - Middle Name:F
Authorized Official - Last Name:EHLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-483-0171
Mailing Address - Street 1:2869 3RD AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-2600
Mailing Address - Country:US
Mailing Address - Phone:701-483-0171
Mailing Address - Fax:701-483-4097
Practice Address - Street 1:2869 3RD AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601
Practice Address - Country:US
Practice Address - Phone:701-483-0171
Practice Address - Fax:701-483-4097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND57985Medicaid
ND57985Medicaid