Provider Demographics
NPI:1144518549
Name:ALTRU HEALTH SYSTEM
Entity type:Organization
Organization Name:ALTRU HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEBEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-780-1470
Mailing Address - Street 1:1200 SOUTH COLUMBIA ROAD
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201
Mailing Address - Country:US
Mailing Address - Phone:701-780-5877
Mailing Address - Fax:701-780-5852
Practice Address - Street 1:711 DELMORE DR
Practice Address - Street 2:
Practice Address - City:ROSEAU
Practice Address - State:MN
Practice Address - Zip Code:56751-1534
Practice Address - Country:US
Practice Address - Phone:701-780-5877
Practice Address - Fax:701-780-5852
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALTRU HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-19
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND243540Medicare UPIN
ND243540Medicare Oscar/Certification