Provider Demographics
NPI:1447871181
Name:SURGE FITNESS LLC
Entity type:Organization
Organization Name:SURGE FITNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CORRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROGNESS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:701-748-3334
Mailing Address - Street 1:1000 HIGHWAY DR
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545-4731
Mailing Address - Country:US
Mailing Address - Phone:701-748-3334
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHWAY DR
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:ND
Practice Address - Zip Code:58545-4731
Practice Address - Country:US
Practice Address - Phone:701-748-3334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center