Provider Demographics
NPI:1801965967
Name:FAMILY HEALTH CARE CENTER
Entity type:Organization
Organization Name:FAMILY HEALTH CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENZ-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-271-1494
Mailing Address - Street 1:301 NP AVE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4835
Mailing Address - Country:US
Mailing Address - Phone:701-271-3344
Mailing Address - Fax:701-551-7533
Practice Address - Street 1:715 11TH ST N
Practice Address - Street 2:SUITE 106B
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-2083
Practice Address - Country:US
Practice Address - Phone:701-239-7111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1459467Medicaid
MN468785000Medicaid