Healthcare Provider Details

I. General information

NPI: 1205916087
Provider Name (Legal Business Name): UNION HOSPITAL SOCIETY OF MAYVILLE ND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 WASHINGTON AVE E
FINLEY ND
58230
US

IV. Provider business mailing address

42 6TH AVE SE
MAYVILLE ND
58257-1506
US

V. Phone/Fax

Practice location:
  • Phone: 701-524-1005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateND

VIII. Authorized Official

Name: ROGER A BAIER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 701-788-3800