Provider Demographics
NPI:1447522206
Name:IAN L GREYBULL
Entity type:Organization
Organization Name:IAN L GREYBULL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CODING/BILLING
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZASTOUPIL
Authorized Official - Suffix:
Authorized Official - Credentials:RHIT
Authorized Official - Phone:701-323-9900
Mailing Address - Street 1:300 W CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-1405
Mailing Address - Country:US
Mailing Address - Phone:701-323-9900
Mailing Address - Fax:701-323-9911
Practice Address - Street 1:300 W CENTURY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-1405
Practice Address - Country:US
Practice Address - Phone:701-323-9900
Practice Address - Fax:701-323-9911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29280261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND84140Medicaid
N717676Medicare PIN