Basic Information
| Provider Information | |||||||||
| NPI: | 1821062514 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DILLON | ||||||||
| FirstName: | JEANNE | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 BROADWAY N | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581023641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012342261 | ||||||||
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| Practice Location | |||||||||
| Address1: | 801 BROADWAY N | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581023641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012342261 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 03/13/2012 | ||||||||
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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 | 207R00000X | 5030 | SD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 10868 | ND | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0555144 | 05 | IA | MEDICAID | 200896300 | 05 | MN | MEDICAID | 57105F009 | 01 | SD | WPS TRICARE | OTHER | 135M7DI | 01 | MN | CC SYSTEMS/ BLUE PLUS | OTHER | 5030 | 01 | SD | DAKOTACARE | OTHER | 0040350 | 01 | SD | BLUE CROSS | OTHER | 0404738 | 01 | SD | MEDICA | OTHER | 141730 | 01 | MN | UCARE | OTHER | 25566 | 01 | SD | SANFORD HEALTH PLAN | OTHER | 46022474335 | 05 | NE | MEDICAID | 769201031092 | 01 | SD | PREFERRED ONE | OTHER | HP37118 | 01 | SD | HEALTHPARTNERS | OTHER | 1650053 | 01 | SD | ARAZ/ AMERICA'S PPO | OTHER | 236597 | 01 | SD | MIDLANDS CHOICE | OTHER | 92411422901 | 01 | MN | PRIMEWEST | OTHER | 110237698 | 01 | SD | RR MEDICARE | OTHER | 6004370 | 05 | SD | MEDICAID |