Ray Family Medical Center, PLLC
Organization Active NPI Physician Assistant · Ray, ND
NPI 1386233138 · NPPES record last updated Sep 28, 2022
Key facts
- NPI
- 1386233138
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physician Assistant 363A00000X
- Legal business name
- RAY FAMILY MEDICAL CENTER, PLLC
- Practice address
- 6439 115TH Ave NW
Suite 2
Ray, ND 58849-4900 - Phone
- (701) 568-2796
- Fax
- (701) 568-5649
- NPI assigned
- Jan 15, 2021
- Organization subpart
- No
Authorized official
- Name
- Brenna L Hudson, PA-C
- Title
- Owner/Physician Assistant
- Phone
- (170) 136-0158
Practitioners 2
-
Brenna L Hudson, PA-C
-
Sarah L Wallace, LCMHC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 35D2192174 | Ray Family Medical Center, PLLC | Certificate of waiver | Sep 7, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210505000740 | ND | Part B Supplier - Clinic/Group Practice | 6406265370 |
Receives reassigned benefits from 1 practitioner Practice locations: Ray, ND |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant |
363A00000X | Yes |
Addresses
Primary practice location
6439 115TH Ave NW
Suite 2
Ray, ND 58849-4900
Mailing address
PO Box 798
Ray, ND 58849-0798
Phone (701) 568-2796
Other providers in Ray, ND
- Anne-Louise Irene Morgan
- Northland Health Centers
- Northwest Therapy Services, LLC.
- Caitlin Olivia Olson
- Ray Community Ambulance District
- Cheryl A Simpson
- Tioga Medical Center
All providers in Ray, ND · Physician Assistant 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 Sep 28, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.