Healthcare Provider Details

I. General information

NPI: 1083706105
Provider Name (Legal Business Name): HILLSBORO MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 3RD ST SE
HILLSBORO ND
58045-4840
US

IV. Provider business mailing address

12 3RD ST SE
HILLSBORO ND
58045-4840
US

V. Phone/Fax

Practice location:
  • Phone: 701-636-3219
  • Fax: 701-636-3206
Mailing address:
  • Phone: 701-636-3219
  • Fax: 701-636-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number56
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number5026PND
License Number StateND

VIII. Authorized Official

Name: JAC MCTAGGART
Title or Position: CEO
Credential:
Phone: 701-636-3201