Dakota Clinic, LTD.
Organization Active NPI Family Medicine Physician · Fargo, ND
NPI 1194777409 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1194777409
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- DAKOTA CLINIC, LTD.
- Practice address
- 3000 32ND Ave S
Fargo, ND 58103-6132 - Phone
- (701) 364-8000
- Fax
- (701) 364-8078
- NPI assigned
- May 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Larry G Solberg
- Title
- Administrator-Authorized Official
- Phone
- (701) 364-3405
Corporate family (same tax ID) 37
Practitioners 2
-
Andrea Lea Johnson, DNP
National Provider Directory
- Tax ID family
- Dakota Clinc Independent la
Locations
1100 19th Ave N
Fargo, ND 58102
Phone (701) 232-6211
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
3000 32ND Ave S
Fargo, ND 58103-6132
Mailing address
PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-8000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10046 | Medicaid | ND |
Other names
- Dakota Clinic, Ltd. at Innovis
Other providers in Fargo, ND
- Dakota Clinic LTD at Innovis
- Dakota Clinic of Chiropractic, PLLC
- Dakota Clinic Pharmacy LLC
- Dakota Clinic Pharmacy LLC
- Dakota Clinic, LTD
- Dakota Clinic, LTD.
- Dakota Clinic, LTD.
- Dakota Clinic, LTD.
- Dakota Clinic, LTD.
- Dakota Clinic, LTD.
All providers in Fargo, ND · Family Medicine Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.