Basic Information
Provider Information
NPI: 1497856025
EntityType: 2
ReplacementNPI:  
OrganizationName: WEST RIVER HEALTH SERVICES
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: BOWMAN CLINIC
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1000 HIGHWAY 12
Address2:  
City: HETTINGER
State: ND
PostalCode: 586397530
CountryCode: US
TelephoneNumber: 7015674561
FaxNumber: 7015676369
Practice Location
Address1: 608 HIGHWAY 12 W
Address2:  
City: BOWMAN
State: ND
PostalCode: 586234507
CountryCode: US
TelephoneNumber: 7015233271
FaxNumber: 7015235593
Other Information
ProviderEnumerationDate: 09/26/2006
LastUpdateDate: 05/14/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: LONG
AuthorizedOfficialFirstName: JAMES
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 7015676184
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QR1300X  Y Ambulatory Health Care FacilitiesClinic/CenterRural Health

ID Information
IDTypeStateIssuerDescription
00000501505ND MEDICAID
5344001205SD MEDICAID


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