Healthcare Provider Details

I. General information

NPI: 1295777951
Provider Name (Legal Business Name): ASHLEY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S MAIN
ZEELAND ND
58581-4014
US

IV. Provider business mailing address

PO BOX 450 612 CENTER AVE N
ASHLEY ND
58413-0450
US

V. Phone/Fax

Practice location:
  • Phone: 701-288-3448
  • Fax: 701-288-3213
Mailing address:
  • Phone: 701-288-3448
  • Fax: 701-288-3213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC HEUPEL
Title or Position: CEO
Credential:
Phone: 701-288-3433