1003052952 NPI number — COAL COUNTRY COMMUNITY HEALTH CENTER

Table of content: (NPI 1003052952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003052952 NPI number — COAL COUNTRY COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COAL COUNTRY COMMUNITY 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:
Provider Other Organization Name Type Code:
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:
1003052952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1312 HIGHWAY 49 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEULAH
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58523-6038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-873-7788
Provider Business Mailing Address Fax Number:
701-639-4709

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTER
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58530-4712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-794-8798
Provider Business Practice Location Address Fax Number:
701-639-4707
Provider Enumeration Date:
12/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BERTSCH
Authorized Official First Name:
DARROLD
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
701-873-4445

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05912 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6103001 . This is a "BCBS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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