Provider Demographics
NPI:1306320213
Name:CENTRAL CLINIC
Entity type:Organization
Organization Name:CENTRAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:701-652-2044
Mailing Address - Street 1:990 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARRINGTON
Mailing Address - State:ND
Mailing Address - Zip Code:58421-2024
Mailing Address - Country:US
Mailing Address - Phone:701-652-2651
Mailing Address - Fax:701-652-1882
Practice Address - Street 1:990 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARRINGTON
Practice Address - State:ND
Practice Address - Zip Code:58421-2024
Practice Address - Country:US
Practice Address - Phone:701-652-2651
Practice Address - Fax:701-652-1882
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL PHARMACY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone