Provider Demographics
NPI:1942569512
Name:PARTNER MEDICAL ND LLC
Entity Type:Organization
Organization Name:PARTNER MEDICAL ND LLC
Other - Org Name:PARTNER MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SEVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-275-0083
Mailing Address - Street 1:5256 50TH AVE S UNIT A
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6075
Mailing Address - Country:US
Mailing Address - Phone:701-356-4813
Mailing Address - Fax:
Practice Address - Street 1:5256 50TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6075
Practice Address - Country:US
Practice Address - Phone:701-356-4813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies