NPIMap

Organization Active NPI

Dakota Clinic, LTD.

Doing business as Dakota Clinic, Ltd. - Lisbon

  • Family Medicine Physician
  • Lisbon, ND
National Provider Identifier
1093766974
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DAKOTA CLINIC, LTD.
Doing business as
Dakota Clinic, Ltd. - Lisbon
Practice address
819 Main St
Lisbon, ND 58054-4244
Phone
(701) 683-4134
Fax
(701) 683-4094
NPI assigned
May 15, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Larry G Solberg
Title
Administrator-Authorized Official
Phone
(701) 364-3405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

819 Main St
Lisbon, ND 58054-4244

Mailing address

401 3Rd St SE
Jamestown, ND 58401-4247
Phone (701) 253-5300

Other identifiers 1

IdentifierTypeStateIssuer
10894MedicaidND

Other names 1

  • Dakota Clinic, Ltd. - Lisbon Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dakota Clin Park Rapids38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093766974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 3RD ST SE",
            "city": "JAMESTOWN",
            "state": "ND",
            "postal_code": "584014247",
            "telephone_number": "701-253-5300",
            "fax_number": "701-253-5402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 MAIN ST",
            "city": "LISBON",
            "state": "ND",
            "postal_code": "580544244",
            "telephone_number": "701-683-4134",
            "fax_number": "701-683-4094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAKOTA CLINIC, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SOLBERG",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "ADMINISTRATOR-AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "701-364-3405"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10894",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dakota Clinic, Ltd. - Lisbon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lisbon, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.