Provider Demographics
NPI:1801145206
Name:ANOVA FAMILY HEALTH CENTER INC.
Entity type:Organization
Organization Name:ANOVA FAMILY HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:VONNIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:701-842-6400
Mailing Address - Street 1:PO BOX 2479
Mailing Address - Street 2:113 MAIN STREET SOUTH
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-2479
Mailing Address - Country:US
Mailing Address - Phone:701-842-6400
Mailing Address - Fax:701-842-6403
Practice Address - Street 1:113 MAIN STREET SOUTH
Practice Address - Street 2:
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854-2479
Practice Address - Country:US
Practice Address - Phone:701-842-6400
Practice Address - Fax:701-842-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
1124279633OtherINDIVIDUAL NPI-VONNIE JOHNSON
1790030187OtherINDIVIDUAL NPI-ANITA PEDERSEN