Maddock, Jerome P

Maddock, Jerome P is an individual health care provider with primary practice located at 900 E Broadway Avenue , Bismarck ND 58501. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Maddock, Jerome P can be contacted via phone (701) 530-7000.

Contact Information

Primary practice address
900 E Broadway Avenue Bismarck ND 58501
Phone: (701) 530-7000
Fax: (701) 530-8842
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X R17473 North Dakota

Profile Details

NPI number 1295888774
LBN Legal business name Maddock, Jerome P
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 19th, 2007
Last updated Jul 8th, 2016 - about 8 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295888774 NPPES
North Dakota MEDICAID 1452782

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