NPIMap

Organization Active NPI

Michigan Community Medical Clinic

  • Clinic/Center
  • Michigan, ND
National Provider Identifier
1427466630
Registry record updated Jul 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
3113 Issued in ND
Legal business name
MICHIGAN COMMUNITY MEDICAL CLINIC
Practice address
115 So St. # 290
Michigan, ND 58259
Phone
(701) 259-2118
Fax
(701) 259-2319
NPI assigned
Jul 31, 2014
Last updated
Jul 31, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2014

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

Authorized official

Name
Dr. Nathan Boyd Hagen, M.D.NPI 1518049931
Title
Physician
Phone
(701) 259-2118

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 3113 ND Primary

Addresses

Primary practice location

115 So St. # 290
Michigan, ND 58259

Mailing address

PO Box 290
115 So St. # 290
Michigan, ND 58259
Phone (701) 259-2118

Other identifiers 1

IdentifierTypeStateIssuer
11257MedicaidND

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406764800000",
    "number": "1427466630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290",
            "address_2": "115 SO ST. # 290",
            "city": "MICHIGAN",
            "state": "ND",
            "postal_code": "58259",
            "telephone_number": "701-259-2118",
            "fax_number": "701-259-2319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 SO ST. # 290",
            "city": "MICHIGAN",
            "state": "ND",
            "postal_code": "58259",
            "telephone_number": "701-259-2118",
            "fax_number": "701-259-2319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN COMMUNITY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-31",
        "last_updated": "2014-07-31",
        "status": "A",
        "authorized_official_last_name": "HAGEN",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "701-259-2118",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "ND",
            "license": "3113",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11257",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Michigan, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2014; 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.