THREE AFFILIATED TRIBES KIDNEY DIALYSIS UNIT NPI 1083625354

NPI Information

NPI: 1083625354
Provider Name: THREE AFFILIATED TRIBES KIDNEY DIALYSIS UNIT
Classification: Clinic/Center - 261QE0700X
Entity Type: Organization

Specialization: End-Stage Renal Disease (ESRD) Treatment

CLIA Number: 35D0877547

Address:
1058 COLLEGE DR STE B
NEW TOWN, ND
ZIP 58763
Phone: (701) 627-4840
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THREE AFFILIATED TRIBES KIDNEY DIALYSIS UNIT is an end-stage renal disease (esrd) treatment clinic center in New Town, ND. THREE AFFILIATED TRIBES KIDNEY DIALYSIS UNIT NPI is 1083625354. The provider is registered as an organization entity type.

The provider's business location address is:

1058 COLLEGE DR STE B
NEW TOWN, ND
ZIP 58763-112
Phone: (701) 627-4840
Fax: (701) 627-4842

The provider's authorized official is Elizabeth Lone Bear .
The authorized official title is Director and has the following contact phone number (701) 627-4840.

The CLIA number assigned to this NPI record is 35D0877547 - end stage renal disease dialysis facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/11/2006 and was last updated on 4/3/2024.

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	261QE0700X	Clinic/Center	End-Stage Renal Disease (ESRD) Treatment			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	01323	MEDICAID	NORTH DAKOTA
2	57787	OTHER	NORTH DAKOTA	MEDICAID TRANSPORTATION
3	09613	OTHER	NORTH DAKOTA	BLUE CROSS BLUE SHIELD

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: 5/5/2024

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