1790751170 NPI number — MERCY HOSPITAL OF DEVILS LAKE

Table of content: (NPI 1790751170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790751170 NPI number — MERCY HOSPITAL OF DEVILS LAKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MERCY HOSPITAL OF DEVILS LAKE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHI ST ALEXIUS HEALTH DEVILS LAKE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790751170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1031 7TH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEVILS LAKE
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58301-2798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-662-2131
Provider Business Mailing Address Fax Number:
701-662-9651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1031 7TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEVILS LAKE
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58301-2798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-662-2131
Provider Business Practice Location Address Fax Number:
701-662-9651
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SARGENT
Authorized Official First Name:
KURT
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OPERATIONAL FINANCE
Authorized Official Telephone Number:
701-237-8064

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1462607 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 076001 . This is a "BLUE CROSS GROUP NUMBER" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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