Clay Burt Broadwell
Individual provider Active NPI Community/Behavioral Health Agency · Bismarck, ND
NPI 1225868797 · NPPES record last updated Aug 7, 2024
Key facts
- NPI
- 1225868797
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Practice address
- 2130 S 12TH St Apt 137
Bismarck, ND 58504-3144 - Phone
- (701) 840-1506
- NPI assigned
- Aug 7, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
2130 S 12TH St Apt 137
Bismarck, ND 58504-3144
Mailing address
2130 S 12TH St Apt 137
Bismarck, ND 58504-3144
Phone (701) 840-1506
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All providers in Bismarck, ND · Community/Behavioral Health Agency 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 7, 2024. 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.