Healthcare Provider Details

I. General information

NPI: 1902824576
Provider Name (Legal Business Name): MERCY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
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 Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number5052
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number5052A
License Number StateND

VIII. Authorized Official

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