MEDICARE: UNION HOSPITAL SOCIETY OF MAYVILLE ND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center		ND

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	70729	OTHER		BC BS ND X-RAY
3	00088001	OTHER	ND	BC BS ND
4	70722	OTHER		BC BS LAB

General Provider Information

NPI Number	:	1205916087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNION HOSPITAL SOCIETY OF MAYVILLE ND

Provider Business Mailing Address
First Line	:	42 6TH AVE SE
Second Line	:
City	:	MAYVILLE
State	:	ND
Zip	:	58257-1506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	407 WASHINGTON AVE E
Second Line	:
City	:	FINLEY
State	:	ND
Zip	:	58230
Country	:	US
Telephone Number	:	701-524-1005
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ROGER A BAIER
Credential	:
Telephone Number	:	701-788-3800

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	06/05/2008

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Directions to “UNION HOSPITAL SOCIETY OF MAYVILLE ND ” Practice Location

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