Healthcare Provider Details

I. General information

NPI: 1700965696
Provider Name (Legal Business Name): HAZEN MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 8TH AVE NE
HAZEN ND
58545-4637
US

IV. Provider business mailing address

510 8TH AVENUE NE
HAZEN ND
58545
US

V. Phone/Fax

Practice location:
  • Phone: 701-748-2225
  • Fax: 701-639-4343
Mailing address:
  • Phone: 701-748-2225
  • Fax: 701-639-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number5024A
License Number StateND

VIII. Authorized Official

Name: MR. KURT WALDBILLIG
Title or Position: CEO
Credential:
Phone: 701-748-2225