Healthcare Provider Details

I. General information

NPI: 1619033917
Provider Name (Legal Business Name): PRESENTATION MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 2ND AVE NE
ROLLA ND
58367-0759
US

IV. Provider business mailing address

PO BOX 759
ROLLA ND
58367-0759
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-3161
  • Fax: 701-477-5564
Mailing address:
  • Phone: 701-477-3161
  • Fax: 701-477-5564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number5045A
License Number StateND

VIII. Authorized Official

Name: MS. PAULA J WILKIE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 701-477-3161