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NPI Code Detail

MEDICARE: COAL COUNTRY COMMUNITY HEALTH CENTER

MEDICARE: COAL COUNTRY COMMUNITY HEALTH CENTER
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
1261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1215640180
Entity Type Code : Organization
Provider Name (Legal Business Name) : COAL COUNTRY COMMUNITY HEALTH CENTER
Provider Business Mailing Address
First Line : 1312 HIGHWAY 49 N
Second Line :
City : BEULAH
State : ND
Zip : 58523-6038
Country : US
Telephone Number : 701-873-4445
Fax Number : 701-639-4709
Provider Business Practice Location Address
First Line : 914 S 12TH ST STE 101A
Second Line :
City : BISMARCK
State : ND
Zip : 58504-5941
Country : US
Telephone Number : 701-873-4445
Fax Number :
Authorized Official
Title or Position : CEO
Name : BRIAN WILLIAMS
Credential :
Telephone Number : 701-873-4445
Provider Enumeration Date : 01/05/2023
Last Update Date : 12/22/2025

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Directions to “COAL COUNTRY COMMUNITY HEALTH CENTER ” Practice Location

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