Provider Demographics
NPI:1730113507
Name:SKOVE, MARCIE GROGAN (PAC)
Entity Type:Individual
Prefix:
First Name:MARCIE
Middle Name:GROGAN
Last Name:SKOVE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:3000 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6132
Practice Address - Country:US
Practice Address - Phone:701-364-8000
Practice Address - Fax:701-364-8078
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0030363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDDA9011015537OtherPREFERRED ONE #
ND0113139OtherMEDICA #
ND42G69GROtherMNBS #
ND974762OtherAMERICA'S PPO/ARAZ #
NDHP38583OtherHEALTHPARTNERS #
ND080977200Medicaid
ND142333OtherUCARE #
ND4682OtherNDBS #
ND0113140OtherMEDICA #
NDHP38583OtherHEALTHPARTNERS #
ND974762OtherAMERICA'S PPO/ARAZ #
ND713115Medicare PIN