Provider Demographics
NPI:1659477149
Name:INDEPENDENT FAMILY DOCTORS
Entity Type:Organization
Organization Name:INDEPENDENT FAMILY DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-234-9400
Mailing Address - Street 1:1711 GOLD DR S STE 160
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6418
Mailing Address - Country:US
Mailing Address - Phone:701-234-9400
Mailing Address - Fax:701-234-9400
Practice Address - Street 1:1711 GOLD DR S STE 160
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6418
Practice Address - Country:US
Practice Address - Phone:701-234-9400
Practice Address - Fax:701-234-9400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty