Provider Demographics
NPI:1811190465
Name:MEDCENTER ONE INC
Entity Type:Organization
Organization Name:MEDCENTER ONE INC
Other - Org Name:MEDCENTER ONE HEALTH SYSTEMS DICKINSON UROLOGY CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF CLINIC FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:LEIGH ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-323-6000
Mailing Address - Street 1:PO BOX 5501
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58506-5501
Mailing Address - Country:US
Mailing Address - Phone:701-323-6000
Mailing Address - Fax:701-323-5709
Practice Address - Street 1:12 1ST ST W
Practice Address - Street 2:CITY CENTER PLAZA
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5106
Practice Address - Country:US
Practice Address - Phone:701-225-2981
Practice Address - Fax:701-323-5709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty