Healthcare Provider Details

I. General information

NPI: 1063420495
Provider Name (Legal Business Name): MCKENZIE COUNTY HEALTHCARE SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 06/09/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 701-842-3771
  • Fax: 701-842-4025
Mailing address:
  • Phone: 701-842-3771
  • Fax: 701-842-4025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

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