=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205916087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNION HOSPITAL SOCIETY OF MAYVILLE ND
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 06/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 407 WASHINGTON AVE E
-----------------------------------------------------
City | FINLEY
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-524-1005
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 42 6TH AVE SE
-----------------------------------------------------
City | MAYVILLE
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58257-1506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | ROGER A BAIER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 701-788-3800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------