Provider Demographics
NPI:1619119591
Name:MIDGARDEN FAMILY CLINIC PC
Entity Type:Organization
Organization Name:MIDGARDEN FAMILY CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MIDGARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-284-6663
Mailing Address - Street 1:503 PARK ST W
Mailing Address - Street 2:
Mailing Address - City:PARK RIVER
Mailing Address - State:ND
Mailing Address - Zip Code:58270-4103
Mailing Address - Country:US
Mailing Address - Phone:701-284-6663
Mailing Address - Fax:701-284-6923
Practice Address - Street 1:503 PARK ST W
Practice Address - Street 2:
Practice Address - City:PARK RIVER
Practice Address - State:ND
Practice Address - Zip Code:58270-4103
Practice Address - Country:US
Practice Address - Phone:701-284-6663
Practice Address - Fax:701-284-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8012261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service