Healthcare Provider Details

I. General information

NPI: 1689364598
Provider Name (Legal Business Name): MCKENZIE COUNTY HEALTHCARE SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 03/19/2024
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 12TH ST SE
WATFORD CITY ND
58854-6722
US

IV. Provider business mailing address

709 4TH AVE NE
WATFORD CITY ND
58854-7628
US

V. Phone/Fax

Practice location:
  • Phone: 701-842-3000
  • Fax: 701-842-6248
Mailing address:
  • Phone: 701-842-3000
  • Fax: 701-842-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER EDIS
Title or Position: CEO
Credential:
Phone: 701-444-8609