MEDICARE: MCKENZIE COUNTY HEALTHCARE SYSTEMS INC

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	208000000X	Pediatrics Physician
2	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1689364598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCKENZIE COUNTY HEALTHCARE SYSTEMS INC

Provider Business Mailing Address
First Line	:	709 4TH AVE NE
Second Line	:
City	:	WATFORD CITY
State	:	ND
Zip	:	58854-7628
Country	:	US
Telephone Number	:	701-842-3000
Fax Number	:	701-842-4025

Provider Business Practice Location Address
First Line	:	301 12TH ST SE
Second Line	:
City	:	WATFORD CITY
State	:	ND
Zip	:	58854-6722
Country	:	US
Telephone Number	:	701-842-3000
Fax Number	:	701-842-6248

Authorized Official
Title or Position	:	CEO
Name	:	PETER EDIS
Credential	:
Telephone Number	:	701-444-8609

Provider Enumeration Date	:	05/12/2023
Last Update Date	:	03/19/2024

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