Healthcare Provider Details

I. General information

NPI: 1003929944
Provider Name (Legal Business Name): JACOBSON MEMORIAL HOSPITAL CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 ASH AVE E
GLEN ULLIN ND
58631
US

IV. Provider business mailing address

PO BOX 367
ELGIN ND
58533-0367
US

V. Phone/Fax

Practice location:
  • Phone: 701-584-2792
  • Fax:
Mailing address:
  • Phone: 701-584-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES OPDAHL
Title or Position: CEO
Credential:
Phone: 701-584-2792