Provider Demographics
NPI:1790732394
Name:NORTH VALLEY FAMILY MEDICINE CLINIC PLC
Entity Type:Organization
Organization Name:NORTH VALLEY FAMILY MEDICINE CLINIC PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:CARIVEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-773-6800
Mailing Address - Street 1:1298 BURBANK
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3712
Mailing Address - Country:US
Mailing Address - Phone:701-772-7758
Mailing Address - Fax:
Practice Address - Street 1:929 CENTRAL AVE NW
Practice Address - Street 2:
Practice Address - City:EAST GRAND FORKS
Practice Address - State:MN
Practice Address - Zip Code:56721-1917
Practice Address - Country:US
Practice Address - Phone:218-773-6800
Practice Address - Fax:218-773-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty