Provider Demographics
NPI:1639367121
Name:MASON ORTH, PC
Entity Type:Organization
Organization Name:MASON ORTH, PC
Other - Org Name:HEALTHSOURCE OF FARGO-MOORHEAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:ORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:701-451-9098
Mailing Address - Street 1:4141 31ST AVE S
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8778
Mailing Address - Country:US
Mailing Address - Phone:701-451-9098
Mailing Address - Fax:701-451-9099
Practice Address - Street 1:4141 31ST AVE S
Practice Address - Street 2:SUITE 102
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8778
Practice Address - Country:US
Practice Address - Phone:701-451-9098
Practice Address - Fax:701-451-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND6154510002Medicare NSC