Provider Demographics
NPI:1386824019
Name:NATHAN A. VERMEDAHL, MD, PLLC
Entity Type:Organization
Organization Name:NATHAN A. VERMEDAHL, MD, PLLC
Other - Org Name:VERMEDAHL FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VERMEDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-244-5668
Mailing Address - Street 1:206 E 16TH ST
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-4802
Mailing Address - Country:US
Mailing Address - Phone:806-244-5668
Mailing Address - Fax:806-244-5912
Practice Address - Street 1:206 E 16TH ST
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-4802
Practice Address - Country:US
Practice Address - Phone:806-244-5668
Practice Address - Fax:806-244-5912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty