Healthcare Provider Details

I. General information

NPI: 1376514240
Provider Name (Legal Business Name): MERCY HOSPITAL OF DEVILS LAKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 4TH AVENUE
DEVILS LAKE ND
58301
US

IV. Provider business mailing address

PO BOX 1195
DEVILS LAKE ND
58301-1195
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-5056
  • Fax: 701-662-6113
Mailing address:
  • Phone: 701-662-5056
  • Fax: 701-662-6113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL J LOFF
Title or Position: CFO
Credential:
Phone: 701-662-2131