Basic Information
| Provider Information | |||||||||
| NPI: | 1730113507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SKOVE | ||||||||
| FirstName: | MARCIE | ||||||||
| MiddleName: | GROGAN | ||||||||
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| Credential: | PAC | ||||||||
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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: | 3000 32ND AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581036132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013648000 | ||||||||
| FaxNumber: | 7013648078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 03/23/2012 | ||||||||
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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 | 363A00000X | PAC0030 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | DA9011015537 | 01 | ND | PREFERRED ONE # | OTHER | 0113139 | 01 | ND | MEDICA # | OTHER | 42G69GR | 01 | ND | MNBS # | OTHER | 974762 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER | HP38583 | 01 | ND | HEALTHPARTNERS # | OTHER | 080977200 | 05 | ND | MEDICAID | 142333 | 01 | ND | UCARE # | OTHER | 4682 | 01 | ND | NDBS # | OTHER | 0113140 | 01 | ND | MEDICA # | OTHER |