Provider Demographics
NPI:1811041270
Name:WINMAR DIAGNOSTICS NORTH CENTRAL, INC.
Entity Type:Organization
Organization Name:WINMAR DIAGNOSTICS NORTH CENTRAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-235-7424
Mailing Address - Street 1:2700 12TH AVE S
Mailing Address - Street 2:STE B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8723
Mailing Address - Country:US
Mailing Address - Phone:701-235-7424
Mailing Address - Fax:701-239-4792
Practice Address - Street 1:2700 12TH AVE S
Practice Address - Street 2:STE B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-8723
Practice Address - Country:US
Practice Address - Phone:701-235-7424
Practice Address - Fax:701-239-4792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN410619900Medicaid
ND13822Medicaid
MN410619900Medicaid