| Dakota Gastroenterology, Ltd | |
|
5049 33rd Ave S Fargo ND 58104-7080 | |
| (701) 356-1001 | |
| (701) 639-4550 |
| Full Name | Dakota Gastroenterology, Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 5049 33rd Ave S, Fargo, North Dakota |
| Authorized Official Name and Position | Fadel Nammour (OWNER) |
| Authorized Official Contact | 7013561001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dakota Gastroenterology, Ltd 5049 33rd Ave S Fargo ND 58104-7080 Ph: (701) 356-1001 | Dakota Gastroenterology, Ltd 5049 33rd Ave S Fargo ND 58104-7080 Ph: (701) 356-1001 |
| NPI Number | 1881024271 |
|---|---|
| Provider Enumeration Date | 11/21/2013 |
| Last Update Date | 05/30/2019 |
| Medicare PECOS PAC ID | 5991921504 |
|---|---|
| Medicare Enrollment ID | O20140716002035 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881024271 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Secondary |
| 261QA1903X | Clinic/center - Ambulatory Surgical | (* (Not Available)) | Primary |
| Provider Name | Fadel E Nammour |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1922039684 PECOS PAC ID: 7113967993 Enrollment ID: I20070921000558 |
| Provider Name | Shelby L Ernest |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962998096 PECOS PAC ID: 4385992049 Enrollment ID: I20180813001689 |
| Provider Name | Denise Marie Stewart |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154956027 PECOS PAC ID: 9133559180 Enrollment ID: I20200415002376 |
| Provider Name | Kaitlin Jo Walters |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144988668 PECOS PAC ID: 3678965480 Enrollment ID: I20220127001605 |
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