| Spectra Health | |
|
212 S 4th St Suite 301 Grand Forks ND 58201-4777 | |
| (701) 757-2100 | |
| (701) 757-0305 |
| Full Name | Spectra Health |
|---|---|
| Speciality | Clinic/Center |
| Location | 212 S 4th St, Grand Forks, North Dakota |
| Authorized Official Name and Position | Ben Shannon (OPERATIONS MANAGER) |
| Authorized Official Contact | 7017572812 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Spectra Health 212 S 4th St Ste 200 Grand Forks ND 58201-4781 Ph: (701) 757-2100 | Spectra Health 212 S 4th St Suite 301 Grand Forks ND 58201-4777 Ph: (701) 757-2100 |
| NPI Number | 1114343423 |
|---|---|
| Provider Enumeration Date | 03/11/2014 |
| Last Update Date | 07/10/2019 |
| Medicare PECOS PAC ID | 8022075258 |
|---|---|
| Medicare Enrollment ID | O20050103000307 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114343423 | NPI | - | NPPES |
| 05925 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Jonathon H Berg |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1073513982 PECOS PAC ID: 3173506904 Enrollment ID: I20040611000275 |
| Provider Name | Condetta H Ness |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326048232 PECOS PAC ID: 5799762811 Enrollment ID: I20040706001228 |
| Provider Name | Beth Ann M Nuelle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003887076 PECOS PAC ID: 3274572144 Enrollment ID: I20050429000321 |
| Provider Name | Christine C Harsell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982861647 PECOS PAC ID: 4688745995 Enrollment ID: I20080613000355 |
| Provider Name | Roberta J Solberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215186523 PECOS PAC ID: 5890863559 Enrollment ID: I20081007000875 |
| Provider Name | Lyle A Hall |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1790858306 PECOS PAC ID: 0446328900 Enrollment ID: I20091203000717 |
| Provider Name | Maridee D Shogren |
|---|---|
| Provider Type | Practitioner - Certified Nurse Midwife (cnm) |
| Provider Identifiers | NPI Number: 1942400247 PECOS PAC ID: 6204023039 Enrollment ID: I20101206001265 |
| Provider Name | Desiree Jagow France |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1164797874 PECOS PAC ID: 3971764317 Enrollment ID: I20120412000138 |
| Provider Name | Kristian Ross Anderson |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1619121662 PECOS PAC ID: 0143387548 Enrollment ID: I20120508000216 |
| Provider Name | David P Sundberg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750693784 PECOS PAC ID: 8325162936 Enrollment ID: I20150227001670 |
| Provider Name | Rebecca A Vigen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922434539 PECOS PAC ID: 6608194063 Enrollment ID: I20150414002750 |
| Provider Name | Lisa M Bernhardt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952718710 PECOS PAC ID: 9032438668 Enrollment ID: I20150504001752 |
| Provider Name | Gail R Halverson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154319911 PECOS PAC ID: 3173830858 Enrollment ID: I20170908002025 |
| Provider Name | Muluh F Fondong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306221460 PECOS PAC ID: 1254648017 Enrollment ID: I20180208002139 |
| Provider Name | Alicia M Mack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225523004 PECOS PAC ID: 5698012698 Enrollment ID: I20190129003242 |
| Provider Name | Kristen M Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982210308 PECOS PAC ID: 0840602439 Enrollment ID: I20201228000362 |
| Provider Name | Priya Janjrukia |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1982489100 PECOS PAC ID: 3476900812 Enrollment ID: I20231107002720 |
| Provider Name | Robin J Landwehr |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1265879480 PECOS PAC ID: 6709229636 Enrollment ID: I20240208000562 |
| Provider Name | Carol A Torgerson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1487923751 PECOS PAC ID: 1557767621 Enrollment ID: I20240212000426 |
| Provider Name | Angela Jones |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1861427700 PECOS PAC ID: 5092151266 Enrollment ID: I20240311000427 |
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