Basic Information
| Provider Information | |||||||||
| NPI: | 1982031746 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TURTLE MOUNTAIN FAMILY MEDICINE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 MAIN STREET NE | ||||||||
| Address2: | |||||||||
| City: | DUNSEITH | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012445800 | ||||||||
| FaxNumber: | 7012445801 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 MAIN STREET NE | ||||||||
| Address2: | |||||||||
| City: | DUNSEITH | ||||||||
| State: | ND | ||||||||
| PostalCode: | 58329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012445800 | ||||||||
| FaxNumber: | 7012445801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2013 | ||||||||
| LastUpdateDate: | 12/09/2014 | ||||||||
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| AuthorizedOfficialLastName: | SELLAND | ||||||||
| AuthorizedOfficialFirstName: | BRIAN | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7012445800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.