Provider Demographics
NPI:1821392093
Name:HOME TOWN HEALTH
Entity Type:Organization
Organization Name:HOME TOWN HEALTH
Other - Org Name:ELGIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WESTON
Authorized Official - Middle Name:MONROE
Authorized Official - Last Name:DENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-584-3010
Mailing Address - Street 1:302 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:ND
Mailing Address - Zip Code:58533
Mailing Address - Country:US
Mailing Address - Phone:701-584-3010
Mailing Address - Fax:701-584-3011
Practice Address - Street 1:302 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:ND
Practice Address - Zip Code:58533
Practice Address - Country:US
Practice Address - Phone:701-584-3010
Practice Address - Fax:701-584-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND4097208D00000X
NDPAC0361363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty