Basic Information
| Provider Information | |||||||||
| NPI: | 1558401554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARTINSON | ||||||||
| FirstName: | ERLING | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 307 | ||||||||
| Address2: | 108 N MAIN STR | ||||||||
| City: | MCVILLE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013224347 | ||||||||
| FaxNumber: | 7013222250 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 N MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | MCVILLE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013224347 | ||||||||
| FaxNumber: | 7013222250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5150 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 13280 | 01 | ND | NCHS MCVILLE BLUE CROSS | OTHER | 21127 | 01 | ND | LAKOTA HEALTH CTR BLUE CR | OTHER |