1821760679 NPI number — COOPERSTOWN MEDICAL 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 1821760679 NPI number — COOPERSTOWN MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COOPERSTOWN MEDICAL 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:
DAKOTA REGIONAL MEDICAL CENTER
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:
1821760679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 12TH ST S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOPERSTOWN
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58425-4501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-786-1709
Provider Business Mailing Address Fax Number:
701-786-7121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 2ND ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKOTA
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58344-7320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-786-1700
Provider Business Practice Location Address Fax Number:
701-786-7121
Provider Enumeration Date:
09/30/2021

Additional Information

Authorized Official

Authorized Official Last Name:
SHAWN
Authorized Official First Name:
KELLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMIN ASSIST/CREDENTIALING
Authorized Official Telephone Number:
701-786-1709

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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