Provider Demographics
NPI:1952348013
Name:DAKOTA SURGERY & LASER CENTER LLC
Entity Type:Organization
Organization Name:DAKOTA SURGERY & LASER CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRORBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-222-3937
Mailing Address - Street 1:200 S 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5675
Mailing Address - Country:US
Mailing Address - Phone:701-222-3937
Mailing Address - Fax:701-222-8805
Practice Address - Street 1:430 E SWEET AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5658
Practice Address - Country:US
Practice Address - Phone:701-222-4900
Practice Address - Fax:701-222-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1452423Medicaid
4900038789OtherRAILROAD MEDICARE ID
SD5490220Medicaid
ND8615OtherBCBS
CN7318OtherRAILROAD MEDICARE ID-CRNA
68-00066OtherMEDICA
ND10666Medicaid
1272830001OtherDMERC
70887OtherCRNA GROUP #
ND01052001OtherBCBS GROUP #
MT7050108Medicaid
8615Medicare PIN
ND8615OtherBCBS
ND01052001OtherBCBS GROUP #