Healthcare Provider Details

I. General information

NPI: 1609972884
Provider Name (Legal Business Name): MERCY HOSPITAL OF DEVILS LAKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 7TH STREET NE
DEVILS LAKE ND
58301-2798
US

IV. Provider business mailing address

1031 7TH STREET NE
DEVILS LAKE ND
58301-2798
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-2131
  • Fax: 701-662-9651
Mailing address:
  • Phone: 701-662-2131
  • Fax: 701-662-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number5012A
License Number StateND

VIII. Authorized Official

Name: KURT SARGENT
Title or Position: VP OPERATIONAL FINANCE
Credential:
Phone: 701-237-8064