Provider Demographics
NPI:1629347489
Name:ALTRU HEALTH SYSTEM
Entity Type:Organization
Organization Name:ALTRU HEALTH SYSTEM
Other - Org Name:ALTRU HEALTH SYSTEM RENAL DIALYSIS CROOKSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-780-5000
Mailing Address - Street 1:2401 DEMERS AVENUE SOUTH
Mailing Address - Street 2:POST OFFICE BOX 13780
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-780-5000
Mailing Address - Fax:701-780-5852
Practice Address - Street 1:400 S MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1808
Practice Address - Country:US
Practice Address - Phone:701-780-5877
Practice Address - Fax:701-780-5852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-23
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND248837Medicare PIN
MN243541Medicare Oscar/Certification
MN243541Medicare UPIN