Provider Demographics
NPI:1245314533
Name:FIRST DISTRICT HEALTH UNIT
Entity type:Organization
Organization Name:FIRST DISTRICT HEALTH UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CLUTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-852-1376
Mailing Address - Street 1:801 11 AVE. SW
Mailing Address - Street 2:PO BOX 1268
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-1268
Mailing Address - Country:US
Mailing Address - Phone:701-852-1376
Mailing Address - Fax:701-852-5043
Practice Address - Street 1:801 11TH AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4274
Practice Address - Country:US
Practice Address - Phone:701-852-1376
Practice Address - Fax:701-852-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND600000290OtherRR MEDICARE
ND10581OtherBLUE CROSS BLUE SHIELD
ND249326Medicaid
ND249327Medicaid
ND600000290OtherRR MEDICARE
ND249326Medicaid
ND600000290OtherRR MEDICARE
ND10581OtherBLUE CROSS BLUE SHIELD
NDN70474Medicare ID - Type Unspecified