Basic Information
Provider Information | |||||||||
NPI: | 1932392693 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SABIITI | ||||||||
FirstName: | JESSE | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 5010 | ||||||||
Address2: |   | ||||||||
City: | MINOT | ||||||||
State: | ND | ||||||||
PostalCode: | 587025010 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7018575650 | ||||||||
FaxNumber: | 7018575031 | ||||||||
Practice Location | |||||||||
Address1: | 307 1ST AVE. NW | ||||||||
Address2: |   | ||||||||
City: | KENMARE | ||||||||
State: | ND | ||||||||
PostalCode: | 58746 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7013854283 | ||||||||
FaxNumber: | 7013854282 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/24/2007 | ||||||||
LastUpdateDate: | 05/10/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 44710 | KY | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 10658 | ND | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 208M00000X | 2016-00142 | NC | N |   | Allopathic & Osteopathic Physicians | Hospitalist |   |
ID Information
ID | Type | State | Issuer | Description | 000000729955 | 01 | KY | BCBS | OTHER | 7100178620 | 05 | KY |   | MEDICAID | P00977424 | 01 | KY | RR MEDICARE | OTHER |