Provider Demographics
NPI:1821822669
Name:DR. PAT'S BLOOD AND CANCER CLINIC
Entity type:Organization
Organization Name:DR. PAT'S BLOOD AND CANCER CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATANIT
Authorized Official - Middle Name:
Authorized Official - Last Name:WATANABOONYAKHET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-838-3728
Mailing Address - Street 1:2110 10TH ST SW STE 1
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2110 10TH ST SW STE 1
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-6468
Practice Address - Country:US
Practice Address - Phone:701-838-3728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty