1255445730 NPI number — CARRINGTON HEALTH CENTER

Table of content: (NPI 1255445730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255445730 NPI number — CARRINGTON HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARRINGTON 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:
CHI ST. ALEXIUS HEALTH CARRINGTON
Provider Other Organization Name Type Code:
3
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:
1255445730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 4TH ST N
Provider Second Line Business Mailing Address:
PO BOX 461
Provider Business Mailing Address City Name:
CARRINGTON
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58421-1217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-652-3141
Provider Business Mailing Address Fax Number:
701-652-3595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 4TH ST N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARRINGTON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58421-1217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-652-3141
Provider Business Practice Location Address Fax Number:
701-652-3595
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SARGENT
Authorized Official First Name:
KURT
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OPERATIONAL FINANCE
Authorized Official Telephone Number:
701-237-8064

Provider Taxonomy Codes

  • Taxonomy code: 275N00000X , with the licence number:  5008P , 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)

  • Identifier: 3293 . This is a "BC/BS OF ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 1925 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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