Provider Demographics
NPI:1588004410
Name:MEDSCAN LABORATORY INC
Entity Type:Organization
Organization Name:MEDSCAN LABORATORY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-577-0498
Mailing Address - Street 1:1502 13TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-3825
Mailing Address - Country:US
Mailing Address - Phone:701-577-0498
Mailing Address - Fax:701-577-0708
Practice Address - Street 1:1502 13TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3825
Practice Address - Country:US
Practice Address - Phone:701-577-0498
Practice Address - Fax:701-577-0708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-25
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND35D0991209291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN719193Medicare PIN