Healthcare Provider Details

I. General information

NPI: 1801928593
Provider Name (Legal Business Name): MERCY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 15TH AVE W
WILLISTON ND
58801-3821
US

IV. Provider business mailing address

1301 15TH AVE W
WILLISTON ND
58801-3821
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-7401
  • Fax: 701-774-7479
Mailing address:
  • Phone: 701-774-7401
  • Fax: 701-774-7479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5052A
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5052A
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5052A
License Number StateND

VIII. Authorized Official

Name: KERRY S. MONSON
Title or Position: VP FINANCE CFO
Credential:
Phone: 701-774-7401