Basic Information
| Provider Information | |||||||||
| NPI: | 1295770857 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORDVIK | ||||||||
| FirstName: | MARIT | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1707 CENTENNIAL BLVD | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581026050 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012317331 | ||||||||
| FaxNumber: | 7012316132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 11/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 6315 | ND | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3T417HO | 01 | ND | MNBS # | OTHER | DA9011015645 | 01 | ND | PREFERRED ONE # | OTHER | HP19492 | 01 | ND | HEALTHPARTNERS # | OTHER | 0105957 | 01 | ND | MEDICA # | OTHER | 0114783 | 01 | ND | MEDICA # | OTHER | ND100031 | 01 | ND | LHS # | OTHER | 142312 | 01 | ND | UCARE # | OTHER | 55A98HO | 01 | ND | MNBS # | OTHER | 053897300 | 05 | ND | MEDICAID | 5D241HO | 01 | ND | MNBS # | OTHER | 17041 | 05 | ND | MEDICAID | 0114922 | 01 | ND | MEDICA # | OTHER | 11676 | 01 | ND | NDBS # | OTHER | 2M611HO | 01 | ND | MNBS # | OTHER | 3T639HO | 01 | MN | MNBS # | OTHER | 574997 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER |