Provider Demographics
NPI:1245309780
Name:COMPREHENSIVE PEDIATRIC CARE, P. C.
Entity type:Organization
Organization Name:COMPREHENSIVE PEDIATRIC CARE, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:FINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-572-7732
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-0696
Mailing Address - Country:US
Mailing Address - Phone:701-572-7732
Mailing Address - Fax:701-572-7997
Practice Address - Street 1:1411 W DAKOTA PKWY STE 2A
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3854
Practice Address - Country:US
Practice Address - Phone:701-572-7732
Practice Address - Fax:701-572-7997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND05412001OtherBLUE SHIELD
ND12772Medicaid