Provider Demographics
NPI:1871771139
Name:IRIS ENTERPRISES, INC.
Entity type:Organization
Organization Name:IRIS ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDORTHIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:BENITA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:NORDENSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:701-356-8637
Mailing Address - Street 1:4650 26TH AVE S
Mailing Address - Street 2:SUITE D
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8525
Mailing Address - Country:US
Mailing Address - Phone:701-356-8637
Mailing Address - Fax:
Practice Address - Street 1:4650 26TH AVE S
Practice Address - Street 2:SUITE D
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8525
Practice Address - Country:US
Practice Address - Phone:701-356-8637
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND6302130001Medicare NSC