PETERSON MEDICAL CLINICS, LLC (NPI# 1699295774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699295774 |
| Entity Type | Organization |
| Organization Name | PETERSON MEDICAL CLINICS, LLC |
| Other Organization Name | RURAL PSYCHIATRY ASSOCIATES |
| Practice Address |
4700 S Washington St Ste G Grand Forks ND 58201-8123 |
| Mailing Address |
Po Box 5210 Grand Forks ND 58206-5210 |
| Practice Telephone | 7012053000 |
| Practice Fax Number | 7017322501 |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2020-01-02 |
| Authorized Official Name | THOMAS M PETERSON (OWNER) |
| Authorized Official Telephone | 7017322500 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
ND | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Rural Psychiatry Associates | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1202 23rd St S Ste 3, Fargo, ND 581032951 | 7014787887 | 7018937887 |
| 519 Anne St Nw Ste A, Bemidji, MN 566014277 | 2184447013 | 2184444318 |
| Street Address |
4700 S WASHINGTON ST STE G |
| City | GRAND FORKS |
| State | ND |
| Zip Code | 58201-8123 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306819941 | David B Eberly | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2006-02-13 |
| 1073137915 | Hannah Lee Abner | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8155 | 2020-06-06 |
| 1255961959 | Mallory Kristen Martha | Registered Nurse | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2020-01-22 |
| 1023663598 | Devon Nicole Anderson | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2019-08-01 |
| 1255983888 | Danielle Collins | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2019-07-13 |
| 1659889798 | Natasha Marie Krebs | Registered Nurse | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2018-01-10 |
| 1730695412 | Mio Watanabe | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2017-12-18 |
| 1972012482 | Mallory Driscoll | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2017-09-27 |
| 1073067823 | Riki Gifford-ferguson | Physician Assistant | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2016-08-10 |
| 1720435175 | Katie Marie Allen | Social Worker | 4700 S Washington St Ste G, Grand Forks, ND 58201-8123 | 2016-05-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255965398 | Development Homes Inc | Intermediate Care Facility, Mentally Retarded | 5509 Cottonwood Street, Grand Forks, ND 58201 | 2020-02-27 |
| 1932753779 | Lydia Pansegrau | Occupational Therapist | 2950 36th Ave S, Apt A-11, Grand Forks, ND 58201 | 2019-07-30 |
| 1407416019 | Kristina Aikens | Optometrist | 1820 S 42nd St, Grand Forks, ND 58201 | 2019-06-17 |
| 1861963209 | Jessica Kovsky | Occupational Therapist | 1375 S Columbia Rd- Altru Performance Center, Grand Forks, ND 58201 | 2018-12-11 |
| 1609345834 | Altru Specialty Services, Inc | Durable Medical Equipment & Medical Supplies | 1375 South Columbia Road, Suite A, Grand Forks, ND 58201 | 2018-11-16 |
| 1225523004 | Alicia Mae Mack | Registered Nurse | 212 S. 4th St. Suite 301, Spectra Health, Grand Forks, ND 58201 | 2018-06-25 |
| 1396260808 | Amber White | Behavior Technician | 2016 S Washington St., Grand Forks, ND 58201 | 2017-08-04 |
| 1225579840 | Kathleen Suzanne Tillman | Psychologist | 2100 S Columbia Road, Suite 202, Family Institute, PC, Grand Forks, ND 58201 | 2017-03-15 |
| 1881148906 | Melissa Pytlik Monson | Physician Assistant | 1380 S Columbia Rd - Altru Family Medcine Center, Grand Forks, ND 58201 | 2016-08-05 |
| 1477936029 | Laura Jane Carlson | Nurse Practitioner | 3165 Demers Avenue - Truyu Aesthetic Center, Grand Forks, ND 58201 | 2015-07-01 |
| Find all providers in zip 58201 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174974877 | Red River Behavioral Health System | Clinic/Center | 1451 44th Ave S, Grand Forks, ND 58201-3434 | 2016-06-24 |
| 1285742262 | Kidney and Hypertension Plc | Clinic/Center | 1451 44th Ave S, Suite 112d, Grand Forks, ND 58201-3434 | 2006-08-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184181091 | Destiny Med Spa Pllc | Clinic/Center | 1415 W Dakota Pkwy Ste 3b, Williston, ND 58801-3885 | 2019-02-27 |
| 1790210318 | Homefield Health, LLC | Clinic/Center | 4141 31st Ave S., Ste 102, Fargo, ND 58104 | 2017-04-21 |
| 1972952034 | H.i.p.p Kids Therapy Plc | Clinic/Center | 2497 Mustang Dr S, Mandan, ND 58554-5910 | 2016-06-09 |
| 1588929004 | Northern Plains Family Medicine and Behavioral Health,p.c. | Clinic/Center | 6400 158th St Se, Menoken, ND 58558-9790 | 2012-07-10 |
| 1689852683 | Three Affiliated Tribes Parshall Health Care Center | Clinic/Center | 107 3rd St Se, Parshall, ND 58770 | 2008-02-01 |
| 1851579858 | Three Affiliated Tribes Mandaree Health Care Center | Clinic/Center | 445 #2 School Street, Mandaree, ND 58757-0000 | 2008-02-01 |
| 1558548909 | Three Affiliated Tribes White Shield Health Care Center | Clinic/Center | 2 Main Street B, Roseglen, ND 58775-0000 | 2008-01-29 |
| 1588841738 | Three Affiliated Tribes Twin Buttes Health Care Center | Clinic/Center | 726 80th Ave Nw, Halliday, ND 58636-4001 | 2008-01-29 |
| 1740473800 | Riverview Healthcare Association | Clinic/Center | 115 Vivian St, Park River, ND 58270 | 2007-08-22 |
| 1306850706 | P R Health Corporation | Clinic/Center | 115 Vivian St., Park River, ND 58270-4540 | 2006-07-28 |
| Find all providers with the same taxonomy | ||||
| City | GRAND FORKS |
| Zip Code | 58201 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.