Provider Demographics
NPI:1770603730
Name:NORTH DAKOTA DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:NORTH DAKOTA DEPARTMENT OF HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DIRK
Authorized Official - Middle Name:DONOVAN
Authorized Official - Last Name:WILKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-329-3256
Mailing Address - Street 1:600 EAST BOULEVARD AVE
Mailing Address - Street 2:DEPT. 301
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58505-0200
Mailing Address - Country:US
Mailing Address - Phone:701-328-2352
Mailing Address - Fax:701-328-1890
Practice Address - Street 1:600 EAST BOULEVARD AVE
Practice Address - Street 2:DEPT. 301
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58505-0200
Practice Address - Country:US
Practice Address - Phone:701-328-2352
Practice Address - Fax:701-328-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND15907Medicaid