Red River Neurology Clinic

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

4231 Issued in ND

Legal business name

RED RIVER NEUROLOGY CLINIC

Practice address

2812 17TH Ave S
Ste D
Grand Forks, ND 58201-4048

Phone

(701) 780-1401

Fax

(701) 780-1404

NPI assigned

Jun 28, 2005

Organization subpart

No

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

Authorized official

Name

Lorae Benson

Title

Manager

Phone

(701) 780-1401

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ross E. Pettit, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • Bemidji, MN
  • NPI 1942371752
  NPD (past)

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255337861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2812 17TH AVE S",
            "address_2": "STE D",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014048",
            "telephone_number": "701-780-1401",
            "fax_number": "701-780-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2812 17TH AVE S",
            "address_2": "STE D",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014048",
            "telephone_number": "701-780-1401",
            "fax_number": "701-780-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED RIVER NEUROLOGY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BENSON",
        "authorized_official_first_name": "LORAE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "701-780-1401"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "ND",
            "license": "4231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16549",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jon F Raymond, MD
• Laura A Raymond, MD
• Stephanie Raza
• Red River Behavioral Health System
• Red River Family Chiropractic, PC
• Red River Stepping Stones
• Camille Redmann, LCSW
• Rehabauthority, LLC
• Rehabilitation Hospital of Grand Forks, LLC
• Cole Rehovsky, DDS

• Neurology Physician in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Neurology Physician in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.