Provider Demographics
NPI:1750307872
Name:BONE & JOINT CENTER PC
Entity Type:Organization
Organization Name:BONE & JOINT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-530-8800
Mailing Address - Street 1:PO BOX 1397
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-1397
Mailing Address - Country:US
Mailing Address - Phone:701-530-8800
Mailing Address - Fax:701-530-8800
Practice Address - Street 1:310 N 9TH ST.
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4508
Practice Address - Country:US
Practice Address - Phone:701-530-8800
Practice Address - Fax:701-530-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12658Medicaid
SD7797780Medicaid
SD7797780Medicaid
ND0310130002Medicare NSC