MEDICARE: NELSON COUNTY HEALTH SYSTEM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NC0060X	Critical Access Hospital	5035P	ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000356	OTHER	ND	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134280860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NELSON COUNTY HEALTH SYSTEM

Provider Business Mailing Address
First Line	:	PO BOX 367
Second Line	:
City	:	MCVILLE
State	:	ND
Zip	:	58254-0367
Country	:	US
Telephone Number	:	701-322-4328
Fax Number	:	701-322-2250

Provider Business Practice Location Address
First Line	:	200 NORTH MAIN STREET
Second Line	:
City	:	MCVILLE
State	:	ND
Zip	:	58254-0367
Country	:	US
Telephone Number	:	701-322-4328
Fax Number	:	701-322-2250

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. BRUCE D BOWERSOX
Credential	:
Telephone Number	:	701-322-4328

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	04/29/2014

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Directions to “NELSON COUNTY HEALTH SYSTEM ” Practice Location

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