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General NPI Number Information
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NPI Number | 1801928593
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Entity Type | Organization
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Legal Business Name | MERCY MEDICAL CENTER
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 1301 15TH AVE W
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City | WILLISTON
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State | ND
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Zip | 58801-3821
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Country | US
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Telephone | 701-774-7401
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Fax | 701-774-7479
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Provider Business Mailing Address
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Address Line | 1301 15TH AVE W
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City | WILLISTON
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State | ND
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Zip | 58801-3821
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Country | US
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Telephone | 701-774-7401
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Fax | 701-774-7479
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Authorized Official
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Title or Position | VP FINANCE CFO
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Name | KERRY S. MONSON
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Credential |
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Telephone | 701-774-7401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5052A
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5052A
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 5052A
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License Number State | ND
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