Provider Demographics
NPI:1144277484
Name:GREAT PLAINS WOMEN'S HEALTH CENTER PC
Entity type:Organization
Organization Name:GREAT PLAINS WOMEN'S HEALTH CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:TONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-774-7687
Mailing Address - Street 1:1700 11TH ST W
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4500
Mailing Address - Country:US
Mailing Address - Phone:701-774-7687
Mailing Address - Fax:701-572-1695
Practice Address - Street 1:1700 11TH ST W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4500
Practice Address - Country:US
Practice Address - Phone:701-774-7687
Practice Address - Fax:701-572-1695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty