Healthcare Provider Details

I. General information

NPI: 1477549111
Provider Name (Legal Business Name): MERCY HOSPITAL OF VALLEY CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 CHAUTAUQUA BLVD
VALLEY CITY ND
58072-3145
US

IV. Provider business mailing address

570 CHAUTAUQUA BLVD
VALLEY CITY ND
58072-3145
US

V. Phone/Fax

Practice location:
  • Phone: 701-845-6400
  • Fax: 701-845-6413
Mailing address:
  • Phone: 701-845-6400
  • Fax: 701-845-6413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number5050
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number5050A
License Number StateND

VIII. Authorized Official

Name: MR. KEITH HEUSER
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-845-6400