Healthcare Provider Details

I. General information

NPI: 1861462442
Provider Name (Legal Business Name): GARRISON MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 3RD AVE SE
GARRISON ND
58540-7235
US

IV. Provider business mailing address

PO BOX 39
GARRISON ND
58540
US

V. Phone/Fax

Practice location:
  • Phone: 701-463-2275
  • Fax: 701-463-2886
Mailing address:
  • Phone: 701-463-2275
  • Fax: 701-463-2886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number5019A
License Number StateND

VIII. Authorized Official

Name: DEAN MATTERN
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-463-2275