| Nicodemus Therapeutic Services Pllc | |
|
525 31st Ave Sw Minot ND 58701-7036 | |
| (701) 355-6800 | |
| Not Available |
| Full Name | Nicodemus Therapeutic Services Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 525 31st Ave Sw, Minot, North Dakota |
| Authorized Official Name and Position | Timothy Scott Starks (THERAPIST) |
| Authorized Official Contact | 7015005430 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicodemus Therapeutic Services Pllc 525 31st Ave Sw Minot ND 58701-7036 Ph: (701) 500-5430 | Nicodemus Therapeutic Services Pllc 525 31st Ave Sw Minot ND 58701-7036 Ph: (701) 355-6800 |
| NPI Number | 1063113108 |
|---|---|
| Provider Enumeration Date | 03/15/2023 |
| Last Update Date | 12/13/2023 |
| Certification Date | 12/12/2023 |
| Medicare PECOS PAC ID | 9537519269 |
|---|---|
| Medicare Enrollment ID | O20231221001308 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063113108 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Timothy S Starks |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699967109 PECOS PAC ID: 0446600175 Enrollment ID: I20231221001352 |
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