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General NPI Number Information
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NPI Number | 1295568376
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Entity Type | Organization
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Legal Business Name | MCKENZIE COUNTY HEALTHCARE SYSTEMS INC
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Dates
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Enumeration Date | 08/23/2024
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 3 4TH ST E
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City | WILLISTON
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State | ND
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Zip | 58801-5350
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Country | US
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Telephone | 701-577-6337
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Fax | 701-577-6338
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Provider Business Mailing Address
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Address Line | 709 4TH AVE NE
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City | WATFORD CITY
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State | ND
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Zip | 58854-7628
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Country | US
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Telephone | 701-842-3000
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Fax | 701-842-4025
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Authorized Official
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Title or Position | CEO
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Name | PETER EDIS
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Credential |
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Telephone | 701-444-8609
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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