Healthcare Provider Details

I. General information

NPI: 1184117293
Provider Name (Legal Business Name): MERCY HOSPITAL OF DEVILS LAKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 09/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 COLLEGE DR S STE 14
DEVILS LAKE ND
58301
US

IV. Provider business mailing address

425 COLLEGE DR S STE 14
DEVILS LAKE ND
58301-3537
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-8662
  • Fax:
Mailing address:
  • Phone: 701-662-8662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number5012
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number5012
License Number StateND

VIII. Authorized Official

Name: ANDREW JOSEPH LANKOWICZ
Title or Position: PRESIDENT
Credential:
Phone: 701-662-2131