Provider Demographics
NPI:1356511661
Name:MID DAKOTA CLINIC WORKLIFE
Entity Type:Organization
Organization Name:MID DAKOTA CLINIC WORKLIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HEEGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-364-4554
Mailing Address - Street 1:2700 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0669
Mailing Address - Country:US
Mailing Address - Phone:701-530-6400
Mailing Address - Fax:701-530-6430
Practice Address - Street 1:401 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4530
Practice Address - Country:US
Practice Address - Phone:701-530-6010
Practice Address - Fax:701-530-6430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID DAKOTA CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-04
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND236003OtherBCBSND