TIMOTHY A PETERSON MD NPI 1134211568

NPI Information

NPI: 1134211568
Provider Name: TIMOTHY A PETERSON, MD
Classification: Preventive Medicine - 2083A0300X
Entity Type: Individual

Specialization: Addiction Medicine

Organization: PETERSON MEDICAL CLINICS LLC

PECOS Registration: Yes

Address:
4700 S WASHINGTON ST STE G
GRAND FORKS, ND
ZIP 58201
Phone: (701) 205-3000
Get Directions

Timothy A Peterson, MD is an addiction medicine preventive medicine in Grand Forks, ND with 32 years of experience. The provider is a physician engaged in the subspecialty practice of Addiction Medicine who specializes in the prevention, evaluation, diagnosis, treatment, and recovery of persons with the disease of addiction. Timothy A Peterson, MD NPI is 1134211568. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4700 S WASHINGTON ST STE G
GRAND FORKS, ND
ZIP 58201-123
Phone: (701) 205-3000
Fax: (701) 732-2501

The NPI 1134211568 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/30/2006 and was last updated on 10/22/2020.

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	207Q00000X	Family Medicine		7777	NORTH DAKOTA	No
2	2083A0300X	Preventive Medicine	Addiction Medicine	7777	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	1456145	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: 11/14/2023

NPI Synchronization or Removal

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