Healthcare Provider Details

I. General information

NPI: 1740378637
Provider Name (Legal Business Name): MOUNTRAIL COUNTY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 6TH ST SE
STANLEY ND
58784-4444
US

IV. Provider business mailing address

PO BOX 399
STANLEY ND
58784-0399
US

V. Phone/Fax

Practice location:
  • Phone: 701-628-2424
  • Fax: 701-628-3990
Mailing address:
  • Phone: 701-628-8602
  • Fax: 701-628-3990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: RYAN GJELLSTAD
Title or Position: BOARD PRESIDENT
Credential:
Phone: 701-371-4930