Provider Demographics
NPI:1447335245
Name:CITY OF FARGO
Entity type:Organization
Organization Name:CITY OF FARGO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-241-1392
Mailing Address - Street 1:1240 25TH ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2367
Mailing Address - Country:US
Mailing Address - Phone:701-241-1360
Mailing Address - Fax:701-241-8559
Practice Address - Street 1:1240 25TH ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2367
Practice Address - Country:US
Practice Address - Phone:701-241-1360
Practice Address - Fax:701-241-8559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN71095OtherMEDICARE PTAN
ND54843Medicaid