Provider Demographics
NPI:1174599070
Name:CITY OF BISMARCK
Entity type:Organization
Organization Name:CITY OF BISMARCK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-355-1540
Mailing Address - Street 1:500 E FRONT AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5689
Mailing Address - Country:US
Mailing Address - Phone:701-355-1540
Mailing Address - Fax:701-221-6883
Practice Address - Street 1:500 E FRONT AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5689
Practice Address - Country:US
Practice Address - Phone:701-355-1540
Practice Address - Fax:701-221-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1457628Medicaid
ND1457628Medicaid