Healthcare Provider Details

I. General information

NPI: 1780784108
Provider Name (Legal Business Name): ASHLEY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 CENTER AVE N
ASHLEY ND
58413-7013
US

IV. Provider business mailing address

PO BOX 450 612 CENTER AVE NORTH
ASHLEY ND
58413-0450
US

V. Phone/Fax

Practice location:
  • Phone: 701-288-3433
  • Fax: 701-288-3938
Mailing address:
  • Phone: 701-288-3433
  • Fax: 701-288-3938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number6012A
License Number StateND

VIII. Authorized Official

Name: MR. JERRY LEE LEPP
Title or Position: ADMINISTRATOR/CEO
Credential:
Phone: 701-288-3433