Provider Demographics
NPI:1235294513
Name:MONTANA-DAKOTA UTILITIES CO., A DIVISION OF MDU RESOURCES GROUP INC.
Entity type:Organization
Organization Name:MONTANA-DAKOTA UTILITIES CO., A DIVISION OF MDU RESOURCES GROUP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRODUCTS & SERVICES COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WETZSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-222-7919
Mailing Address - Street 1:400 N 4TH ST
Mailing Address - Street 2:ATTN DAWN WETZSTEIN
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4092
Mailing Address - Country:US
Mailing Address - Phone:701-222-7900
Mailing Address - Fax:701-222-7886
Practice Address - Street 1:400 N 4TH ST
Practice Address - Street 2:ATTN DAWN WETZSTEIN
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4092
Practice Address - Country:US
Practice Address - Phone:701-222-7900
Practice Address - Fax:701-222-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0800632OtherINDIVIDUAL PROVIDER
ND33046OtherQUALIFIED SERVICE PROVIDE
SD9560460Medicaid