FAIRLIGHT MEDICAL CENTER NPI 1104079409

NPI Information

NPI: 1104079409
Provider Name: FAIRLIGHT MEDICAL CENTER

Former Legal Business Name: WILLISTON RADIOLOGY CONSULTANTS

Classification: Clinic/Center - 261QU0200X
Entity Type: Organization

Specialization: Urgent Care

Address:
3 4TH ST E
SUITE 101
WILLISTON, ND
ZIP 58801
Phone: (701) 577-6337
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FAIRLIGHT MEDICAL CENTER is an urgent care clinic center in Williston, ND. FAIRLIGHT MEDICAL CENTER NPI is 1104079409. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Williston Radiology Consultants.

The provider's business location address is:

3 4TH ST E
SUITE 101
WILLISTON, ND
ZIP 58801-350
Phone: (701) 577-6337
Fax: (701) 577-4867

The provider's authorized official is Nancy Marie Reiger .
The authorized official title is Billing/insurance Clerk and has the following contact phone number (701) 577-6337.

The CLIA number assigned to this NPI record is 35D1071178 - ancillary testing site in health care center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/30/2008 and was last updated on 10/30/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QU0200X	Clinic/Center	Urgent Care	6414	NORTH DAKOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	109956169	OTHER		DUNS
2	621-11	OTHER		NAICS
3	2699617243	OTHER		TPIN
4	0406731	MEDICAID	MONTANA
5	N6228	MEDICARE PIN	NORTH DAKOTA
6	010182	MEDICAID	NORTH DAKOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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