Mid Dakota Clinic Mammography

Primary specialty

Mammography Clinic/CenterTaxonomy code 261QR0206X

License

125369 Issued in ND

Legal business name

MID DAKOTA CLINIC MAMMOGRAPHY

Practice address

401 N 9TH St
Bismarck, ND 58501-4530

Phone

(701) 530-6000

Fax

(701) 530-6430

NPI assigned

May 9, 2007

Organization subpart

Yes

Parent organization

MID DAKOTA CLINIC, INC.As reported in NPPES

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

Authorized official

Name

Mr. William Heegaard

Title

President

Phone

(701) 364-4554

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Bury Ric2 organizations share this tax ID, including this one

Part of

Bury Ric

Other organizations with this tax ID 1

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

• Mid Dakota Clinic Worklife

  • Occupational Medicine Physician
  • Bismarck, ND
  • NPI 1356511661
  NPD tax ID

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

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1801000294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N 9TH ST",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014530",
            "telephone_number": "701-530-6000",
            "fax_number": "701-530-6430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N 9TH ST",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585014530",
            "telephone_number": "701-530-6000",
            "fax_number": "701-530-6430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID DAKOTA CLINIC MAMMOGRAPHY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MID DAKOTA CLINIC, INC.",
        "enumeration_date": "2007-05-09",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A",
        "authorized_official_last_name": "HEEGAARD",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "701-364-4554",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0206X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology, Mammography",
            "state": "ND",
            "license": "125369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA #",
            "identifier": "125369",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angie Marie Michel
• Micil LLC (MICIL Health Services)
• Micil LLC (MICIL Health Services)
• David Mickelson, MS/LAC
• Scot Mickelson, D.O.
• Mid Dakota Clinic Worklife
• Mid Dakota Clinic, Inc.
• Mid Dakota Clinic, Inc.
• Mid Dakota Clinic, Inc.
• Midstokke Family Dentistry

• Mammography Clinic/Center in Bismarck, ND
• Providers in Bismarck, ND by specialty
• Mammography Clinic/Center in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; 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.