Provider Demographics
NPI:1538212162
Name:BISMARCK CANCER CENTER
Entity type:Organization
Organization Name:BISMARCK CANCER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL AND SUPPORT SERVICES MANA
Authorized Official - Prefix:
Authorized Official - First Name:LOLITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-222-6102
Mailing Address - Street 1:500 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4445
Mailing Address - Country:US
Mailing Address - Phone:701-222-6100
Mailing Address - Fax:701-222-6150
Practice Address - Street 1:500 N 8TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4445
Practice Address - Country:US
Practice Address - Phone:701-222-6100
Practice Address - Fax:701-222-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND24-00390OtherMEDICA
ND24-00348OtherMEDICA
ND14991Medicaid
ND11128Medicaid
ND1356585293OtherBCBS OF ND
ND15295Medicaid
ND1558450841OtherBCBS OF ND
P00779537OtherRAIL ROAD MEDICARE
NDN714489Medicare PIN
ND24-00390OtherMEDICA
P00779537OtherRAIL ROAD MEDICARE
NDN71029Medicare ID - Type UnspecifiedOFFICE GROUP MEDICARE