Healthcare Provider Details

I. General information

NPI: 1043280696
Provider Name (Legal Business Name): TIOGA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 N WELO ST
TIOGA ND
58852-7157
US

IV. Provider business mailing address

PO BOX 159
TIOGA ND
58852-0159
US

V. Phone/Fax

Practice location:
  • Phone: 701-664-3305
  • Fax: 701-664-2240
Mailing address:
  • Phone: 701-664-3305
  • Fax: 701-664-2240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number5048P
License Number StateND

VIII. Authorized Official

Name: RANDALL K PEDERSON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 701-664-3305