NPIMap

Organization Active NPI

Dakota Clinic, LTD.

Doing business as Dakota Clinic, Ltd. - Northport

  • Family Medicine Physician
  • Fargo, ND
National Provider Identifier
1679525745
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DAKOTA CLINIC, LTD.
Doing business as
Dakota Clinic, Ltd. - Northport
Practice address
2710 Broadway N
Fargo, ND 58102-1408
Phone
(701) 364-9001
Fax
(701) 364-9005
NPI assigned
May 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Larry G Solberg
Title
Administrator - Authorized Official
Phone
(701) 364-3405

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2710 Broadway N
Fargo, ND 58102-1408

Mailing address

PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-3300

Other identifiers 1

IdentifierTypeStateIssuer
10046MedicaidND

Other names 1

  • Dakota Clinic, Ltd. - Northport Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dakota Clin Park Rapids38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Locations

2710 Broadway N
Fargo, ND 58102
Phone (701) 364-9001

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": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1679525745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6001",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581086001",
            "telephone_number": "701-364-3300",
            "fax_number": "701-364-8906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2710 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581021408",
            "telephone_number": "701-364-9001",
            "fax_number": "701-364-9005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAKOTA CLINIC, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SOLBERG",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "ADMINISTRATOR - AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "701-364-3405"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10046",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dakota Clinic, Ltd. - Northport",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

  • 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.