Healthcare Provider Details

I. General information

NPI: 1760549000
Provider Name (Legal Business Name): MERCY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 15TH AVE W
WILLISTON ND
58801
US

IV. Provider business mailing address

1213 15TH AVE W
WILLISTON ND
58801-3800
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-7470
  • Fax:
Mailing address:
  • Phone: 701-774-7470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number5052
License Number StateND

VIII. Authorized Official

Name: JOSEPH RUARK
Title or Position: VP-OPERATIONAL FINANCE
Credential:
Phone: 701-774-7400