Healthcare Provider Details

I. General information

NPI: 1992528657
Provider Name (Legal Business Name): ALTRU HOSPITAL-DEVILS LAKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 7TH ST NE
DEVILS LAKE ND
58301-2719
US

IV. Provider business mailing address

PO BOX 13780
GRAND FORKS ND
58208-3780
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DEREK GOEBEL
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 701-780-1470