Provider Demographics
NPI:1477153534
Name:MINOT STATE UNIVERSITY
Entity Type:Organization
Organization Name:MINOT STATE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:V.P FOR ADMINISTRATION AND FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:WINIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-858-3321
Mailing Address - Street 1:500 UNIVERSITY AVE. W.
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY AVE. W.
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58707
Practice Address - Country:US
Practice Address - Phone:701-858-3054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1456607OtherHE MMIS