Healthcare Provider Details

I. General information

NPI: 1174597173
Provider Name (Legal Business Name): HAZEN MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

517 8TH AVE NE
HAZEN ND
58545-4638
US

IV. Provider business mailing address

517 8TH AVE NE
HAZEN ND
58545-4638
US

V. Phone/Fax

Practice location:
  • Phone: 701-748-2256
  • Fax: 701-748-2257
Mailing address:
  • Phone: 701-748-2256
  • Fax: 701-748-2257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number353444
License Number StateND

VIII. Authorized Official

Name: JAMES MARSHALL
Title or Position: CEO
Credential:
Phone: 701-748-2225