Provider Demographics
NPI:1730307125
Name:TRENTON INDIAN SERVICE AREA
Entity Type:Organization
Organization Name:TRENTON INDIAN SERVICE AREA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LADUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-774-8316
Mailing Address - Street 1:331 4TH AVE E
Mailing Address - Street 2:PO BOX 210
Mailing Address - City:TRENTON
Mailing Address - State:ND
Mailing Address - Zip Code:58853-9998
Mailing Address - Country:US
Mailing Address - Phone:701-774-0461
Mailing Address - Fax:701-774-8003
Practice Address - Street 1:331 4TH AVE E
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:ND
Practice Address - Zip Code:58853-9998
Practice Address - Country:US
Practice Address - Phone:701-774-0461
Practice Address - Fax:701-774-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND35D0409330OtherCLIA NO
ND287001OtherBCBS
ND1312Medicaid