Provider Demographics
NPI:1316008238
Name:UNIVERSITY OF NORTH DAKOTA
Entity type:Organization
Organization Name:UNIVERSITY OF NORTH DAKOTA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:TURNER
Authorized Official - Last Name:KROHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-858-6700
Mailing Address - Street 1:1201 11TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4207
Mailing Address - Country:US
Mailing Address - Phone:701-858-6700
Mailing Address - Fax:701-858-6749
Practice Address - Street 1:1201 11TH AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4207
Practice Address - Country:US
Practice Address - Phone:701-858-6700
Practice Address - Fax:701-858-6749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11943Medicaid
NDN6262Medicare UPIN