Provider Demographics
NPI:1851579858
Name:THREE AFFILIATED TRIBES MANDAREE HEALTH CARE CENTER
Entity Type:Organization
Organization Name:THREE AFFILIATED TRIBES MANDAREE HEALTH CARE CENTER
Other - Org Name:MANDAREE HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:D
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:701-627-4781
Mailing Address - Street 1:404 FRONTAGE RD
Mailing Address - Street 2:
Mailing Address - City:NEW TOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58763-9404
Mailing Address - Country:US
Mailing Address - Phone:701-627-4781
Mailing Address - Fax:701-627-3805
Practice Address - Street 1:445 #2 SCHOOL STREET
Practice Address - Street 2:
Practice Address - City:MANDAREE
Practice Address - State:ND
Practice Address - Zip Code:58757-0000
Practice Address - Country:US
Practice Address - Phone:701-627-4781
Practice Address - Fax:701-627-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty