Provider Demographics
NPI:1679326862
Name:MEDCANVAS PSYCHIATRY LLC
Entity type:Organization
Organization Name:MEDCANVAS PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:NTOE
Authorized Official - Last Name:ARRAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-448-0376
Mailing Address - Street 1:1940 S BROADWAY # 420
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-6508
Mailing Address - Country:US
Mailing Address - Phone:701-581-5395
Mailing Address - Fax:
Practice Address - Street 1:801 10TH AVE SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4810
Practice Address - Country:US
Practice Address - Phone:307-448-0376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health