Spectra Health

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SPECTRA HEALTH

Practice address

607 Towner Ave
Larimore, ND 58251-4501

Phone

(701) 343-6418

NPI assigned

May 19, 2021

Organization subpart

No

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

Authorized official

Name

Tiffany Schmidt, MBA, CPA

Title

Cfo

Phone

(701) 757-2100

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Valley Community Health Centers Former legal business name

Tax ID family

Valley Community HLTH CTRS4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

• Spectra Health

  • Federally Qualified Health Center (FQHC)
  • Larimore, ND
  • NPI 1255317905
  NPD tax ID
• Spectra Health

  • Federally Qualified Health Center (FQHC)
  • Grand Forks, ND
  • NPI 1689878324
  NPD tax ID
• Spectra Health

  • Federally Qualified Health Center (FQHC)
  • Grand Forks, ND
  • NPI 1841953379
  NPD tax ID

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

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631491200000",
    "number": "1104490622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 S 4TH ST STE 200",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014781",
            "telephone_number": "701-757-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 TOWNER AVE",
            "city": "LARIMORE",
            "state": "ND",
            "postal_code": "582514501",
            "telephone_number": "701-343-6418"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "212 S 4th St Ste 301",
            "address_purpose": "LOCATION",
            "city": "Grand Forks",
            "state": "ND",
            "postal_code": "582014776",
            "country_code": "US",
            "telephone_number": "701-757-2100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPECTRA HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-19",
        "last_updated": "2021-09-13",
        "certification_date": "2021-06-30",
        "status": "A",
        "authorized_official_last_name": "SCHMIDT",
        "authorized_official_first_name": "TIFFANY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "701-757-2100",
        "authorized_official_credential": "MBA, CPA"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1461963",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1461598",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Valley Community Health Centers",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Valley Community Health Centers",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Northwood Deaconess Health Center
• Salesha Olson
• Pharmacists Associates LLC
• Shauna Rae Sather
• Jessica M Skjordal, LPN
• Spectra Health
• The Evangelical Lutheran Good Samaritan Society
• The Evangelical Lutheran Good Samaritan Society
• The Evangelical Lutheran Good Samaritan Society
• Matthew Jon Volk, DDS

• All providers in Larimore, ND
• Federally Qualified Health Center (FQHC) in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; 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.