Provider Demographics
NPI:1609935311
Name:DAKOTA CLINIC LTD
Entity Type:Organization
Organization Name:DAKOTA CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR-AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:SOLBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-364-3300
Mailing Address - Street 1:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAKOTA CLINIC, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-08
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND108761OtherMAMMOGRAPHY #
ND108761OtherMAMMOGRAPHY #