Provider Demographics
NPI:1861540064
Name:MILESTONE THERAPEUTICS INC
Entity type:Organization
Organization Name:MILESTONE THERAPEUTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTRL
Authorized Official - Phone:701-793-3646
Mailing Address - Street 1:921 43RD AVE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-5320
Mailing Address - Country:US
Mailing Address - Phone:701-793-3646
Mailing Address - Fax:701-293-6892
Practice Address - Street 1:921 43RD AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-5320
Practice Address - Country:US
Practice Address - Phone:701-793-3646
Practice Address - Fax:701-293-6892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1042648OtherPREFERRED ONE PROV. NUM.
ND6345001OtherBCBS ND CLINIC NUMBER
ND64-05519OtherMEDICA PROVIDER NUMBER
ND54893OtherND MA PROVIDER NUMBER
ND107041OtherHEALTH PARTNERS PROV. #
ND371G1MIOtherEPNI PROVIDER NUMBER
MN371G1MIOtherBCBS MN PROVIDER NUMBER