Mandaree Community Clinic

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

License

38,708,300 Issued in ND

Legal business name

MANDAREE COMMUNITY CLINIC

Practice address

404 Ridge Road
Mandaree, ND 58757

Phone

(701) 421-1357

NPI assigned

Jun 17, 2015

Last updated

Feb 15, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kurt Benji Kitagawa, DO

Title

Medical Director

Phone

(308) 660-9321

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455494400000",
    "number": "1194106997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 EAST C STREET",
            "city": "NORTH PLATTE",
            "state": "NE",
            "postal_code": "69101",
            "telephone_number": "308-660-9321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 RIDGE ROAD",
            "city": "MANDAREE",
            "state": "ND",
            "postal_code": "58757",
            "telephone_number": "701-421-1357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANDAREE COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-17",
        "last_updated": "2016-02-15",
        "status": "A",
        "authorized_official_last_name": "KITAGAWA",
        "authorized_official_first_name": "KURT",
        "authorized_official_middle_name": "BENJI",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "308-660-9321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "ND",
            "license": "38,708,300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Health Clinic/Center in Mandaree, ND
• Providers in Mandaree, ND by specialty
• Community Health Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2016; 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.