| Dr. Bauer-olson, Family Doctor, Pllc | |
|
4133 30th Ave S Ste 103 Fargo ND 58104-8421 | |
| (701) 499-4847 | |
| (701) 433-1882 |
| Full Name | Dr. Bauer-olson, Family Doctor, Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 4133 30th Ave S Ste 103, Fargo, North Dakota |
| Authorized Official Name and Position | Cheryl K Bauer-olson (OWNER) |
| Authorized Official Contact | 7014994847 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Bauer-olson, Family Doctor, Pllc 2413 E Country Club Dr S Fargo ND 58103-5730 Ph: (701) 429-4385 | Dr. Bauer-olson, Family Doctor, Pllc 4133 30th Ave S Ste 103 Fargo ND 58104-8421 Ph: (701) 499-4847 |
| NPI Number | 1588234066 |
|---|---|
| Provider Enumeration Date | 06/28/2021 |
| Last Update Date | 05/15/2023 |
| Medicare PECOS PAC ID | 9335547058 |
|---|---|
| Medicare Enrollment ID | O20211011002980 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588234066 | NPI | - | NPPES |
| 14436 | Medicaid | ND | |
| 1484174 | Medicaid | ND | |
| 4754236 | Other | MN | BCBSMN |
| 1588234066 | Other | ND | NDBS |
| 1588234066 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Cheryl K Bauer-olson |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871553313 PECOS PAC ID: 0547281826 Enrollment ID: I20080610000295 |
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