Healthcare Provider Details

I. General information

NPI: 1336529015
Provider Name (Legal Business Name): QUENTIN N BURDICK COMPREHENSIVE HEALTH CARE FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2015
Last Update Date: 06/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HOSPITAL LOOP
BELCOURT ND
58316-0160
US

IV. Provider business mailing address

PO BOX 160
BELCOURT ND
58316-0160
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-6111
  • Fax: 701-477-2500
Mailing address:
  • Phone: 701-477-6111
  • Fax: 701-477-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. DELAND J. DAVIS
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 701-477-6111