Healthcare Provider Details

I. General information

NPI: 1689842478
Provider Name (Legal Business Name): COMMUNITY MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 2ND ST. EAST
MCCLUSKY ND
58463-0618
US

IV. Provider business mailing address

220 5TH AVE W
TURTLE LAKE ND
58575-0280
US

V. Phone/Fax

Practice location:
  • Phone: 701-363-2296
  • Fax: 701-363-2762
Mailing address:
  • Phone: 701-448-2331
  • Fax: 701-448-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERRY FUELLER
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 701-448-2331