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 | 251B00000X | Case Management | | | | Yes |
| 2 | 261QH0100X | Clinic/Center | Health Service | | NORTH DAKOTA | No |
| 3 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | NORTH DAKOTA | No |
| 4 | 261QP0905X | Clinic/Center | Public Health, State or Local | | NORTH DAKOTA | No |
| 5 | 261QP1100X | Clinic/Center | Podiatric | | NORTH DAKOTA | No |
| 6 | 261QP2300X | Clinic/Center | Primary Care | | NORTH DAKOTA | No |
| 7 | 261QR0206X | Clinic/Center | Radiology, Mammography | | NORTH DAKOTA | No |
| 8 | 291U00000X | Clinical Medical Laboratory | | | NORTH DAKOTA | No |
| 9 | 3416L0300X | Ambulance | Land Transport | | NORTH DAKOTA | No |
| 10 | 343900000X | Non-emergency Medical Transport (VAN) | | | | No |
| 11 | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | | | NORTH DAKOTA | No |
| 12 | 171M00000X | Case Manager/Care Coordinator | | | | No |
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 | 1466035 | MEDICAID | NORTH DAKOTA | |
