Provider Demographics
NPI:1447297189
Name:FORTNEY, AARON C (MD)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:C
Last Name:FORTNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4208 OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-8839
Mailing Address - Country:US
Mailing Address - Phone:701-224-0302
Mailing Address - Fax:
Practice Address - Street 1:3119 N 14TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0664
Practice Address - Country:US
Practice Address - Phone:701-222-3937
Practice Address - Fax:701-255-3493
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND9372207W00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1453551Medicaid
33056OtherSIOUX VALLEY HEALTH PLAN
SD7708690Medicaid
08-01410OtherMEDICA - NORTH CLINIC
ND25365OtherBCBS - HAZEN
08-01411OtherMEDICA - MAIN CLINIC
ND23307OtherBCBS - MAIN CLINIC
ND24736OtherBCBS - NORTH CLINIC
ND25366OtherBCBS - BEULAH
488241044241OtherPREFERRED ONE
08-01413OtherMEDICA - SURGERY CENTER
ND12344Medicaid
MT3501056Medicaid
P00053454OtherRAILROAD MEDICARE ID
33056OtherSIOUX VALLEY HEALTH PLAN
08-01413OtherMEDICA - SURGERY CENTER