| Bismarck Surgical Associates, Llc | |
|
106 E Greenfield Ln Bismarck ND 58503-6578 | |
| (701) 221-2299 | |
| (701) 323-3388 |
| Full Name | Bismarck Surgical Associates, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 106 E Greenfield Ln, Bismarck, North Dakota |
| Authorized Official Name and Position | Attas Boutrous (ADMINISTRATOR) |
| Authorized Official Contact | 7012212299 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bismarck Surgical Associates, Llc 106 E Greenfield Ln Bismarck ND 58503-6578 Ph: (701) 221-2299 | Bismarck Surgical Associates, Llc 106 E Greenfield Ln Bismarck ND 58503-6578 Ph: (701) 221-2299 |
| NPI Number | 1255339628 |
|---|---|
| Provider Enumeration Date | 07/11/2005 |
| Last Update Date | 10/24/2019 |
| Medicare PECOS PAC ID | 6800855099 |
|---|---|
| Medicare Enrollment ID | O20080327000049 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255339628 | NPI | - | NPPES |
| 10864 | Medicaid | ND | |
| 5490260 | Medicaid | SD | |
| 1462920 | Medicaid | ND | |
| 490004061 | Other | ND | RAILROAD MEDICARE |
| 8618 | Other | ND | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 261QA1903X | Clinic/center - Ambulatory Surgical | (North Dakota) | Primary |
| Provider Name | Chad B Carlson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1588873186 PECOS PAC ID: 2466585989 Enrollment ID: I20110721000909 |
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