Provider Demographics
NPI:1700343639
Name:WINMAR DIAGNOSTICS NORTH CENTRAL, INC.
Entity Type:Organization
Organization Name:WINMAR DIAGNOSTICS NORTH CENTRAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMPF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-235-7424
Mailing Address - Street 1:2700 12TH AVE S STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-8723
Mailing Address - Country:US
Mailing Address - Phone:701-235-7424
Mailing Address - Fax:701-239-4792
Practice Address - Street 1:2424 32ND AVE S STE 101A
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-6509
Practice Address - Country:US
Practice Address - Phone:701-746-7378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies