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General NPI Number Information
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NPI Number | 1376635151
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Entity Type | Organization
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Legal Business Name | COOPERSTOWN MEDICAL CENTER
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 107 12TH ST S
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City | COOPERSTOWN
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State | ND
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Zip | 58425-4501
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Country | US
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Telephone | 701-786-1700
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Fax | 701-786-7121
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Provider Business Mailing Address
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Address Line | 107 12TH ST S
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City | COOPERSTOWN
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State | ND
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Zip | 58425-4501
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Country | US
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Telephone | 701-786-1700
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Fax | 701-786-7121
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Authorized Official
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Title or Position | ADMIN ASSIST/CREDENTIALING
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Name | KELLEY SHAWN
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Credential |
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Telephone | 701-786-1709
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | 5001P
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License Number State | ND
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