Provider Demographics
NPI:1538617642
Name:ACCESS INDEPENDENT HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:ACCESS INDEPENDENT HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMI
Authorized Official - Middle Name:
Authorized Official - Last Name:KROMENAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-298-9999
Mailing Address - Street 1:512 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4804
Mailing Address - Country:US
Mailing Address - Phone:701-298-9999
Mailing Address - Fax:
Practice Address - Street 1:512 1ST AVE N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4804
Practice Address - Country:US
Practice Address - Phone:701-298-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-18
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center