Provider Demographics
NPI:1396774550
Name:MIDLAND PROHEALTH
Entity type:Organization
Organization Name:MIDLAND PROHEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:GEIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-277-1993
Mailing Address - Street 1:3003 32ND AVE S
Mailing Address - Street 2:#7
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6163
Mailing Address - Country:US
Mailing Address - Phone:701-277-1993
Mailing Address - Fax:701-277-3192
Practice Address - Street 1:3003 32ND AVE S
Practice Address - Street 2:#7
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6163
Practice Address - Country:US
Practice Address - Phone:701-277-1993
Practice Address - Fax:701-277-3192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9150240Medicaid
MN39354OtherHEALTH PARTNERS
45036OtherCOMP CARE
45036MIOtherCIGNA EMPLOYEE
MHE432581OtherPGA PROCARE
MN45036MIOtherBLUE PLUS
MN45036MIOtherBCBS
MT5603806OtherMEDICAID
ND56385Medicaid
ND7871OtherBCBS
MN76571OtherHEALTH PARTNERS
MN8200344OtherMEDICA
ND70510OtherBCBS
ND56385Medicaid
0140270001Medicare ID - Type Unspecified