Rolla Clinic, P.C.
Organization Active NPI Family Medicine Physician · Rolla, ND
NPI 1215948435 · NPPES record last updated Apr 21, 2010
Key facts
- NPI
- 1215948435
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 9041 (ND)
- Legal business name
- ROLLA CLINIC, P.C.
- Practice address
- 114 3Rd St NE
Rolla, ND 58367-7137 - Phone
- (701) 477-3111
- Fax
- (701) 477-6342
- NPI assigned
- Aug 11, 2006
- Organization subpart
- No
Authorized official
- Name
- June A Banse
- Title
- Administrator
- Phone
- (701) 477-3111
Practitioners 7
-
Lavonne M Charbonneau, PA-C
-
Mark G Peterson, MD
-
Katherine Trahan Edwards, FNP-C
-
Duane D Glasner, M.D.
-
Julian Good, FNP, PMHNP
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 9041 | ND | Yes |
Addresses
Primary practice location
114 3Rd St NE
Rolla, ND 58367-7137
Mailing address
PO Box 699
114 NE 3Rd St
Rolla, ND 58367-7137
Phone (701) 477-3111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 05018 | Medicaid | ND | |
| 10151 | Medicaid | ND |
Other providers in Rolla, ND
- Presentation Medical Center
- Presentation Medical Center
- Presentation Medical Center
- Rolette County Public Health
- Rolette County Social Services
- Rolla Drug Inc
- Rolla Eye Clinic
- Patricia J Sitter
- Nevaeh St Germaine
- Joseph A Thorman
All providers in Rolla, 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 Apr 21, 2010. 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.