1124051230 NPI number — ST JOSEPHS HOSPITAL AND HEALTH CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124051230 NPI number — ST JOSEPHS HOSPITAL AND HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JOSEPHS HOSPITAL AND HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CATHOLIC HEALTH INITIATIVES
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124051230
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
584 12TH STREET WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DICKINSON
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58601-3509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-456-4364
Provider Business Mailing Address Fax Number:
701-456-4642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
584 12TH ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DICKINSON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58601-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-456-4364
Provider Business Practice Location Address Fax Number:
701-456-4642
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REYMAN
Authorized Official First Name:
REED
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
701-456-4271

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  5054A , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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