Provider Demographics
NPI:1003052952
Name:COAL COUNTRY COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:COAL COUNTRY COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-873-4445
Mailing Address - Street 1:1312 HIGHWAY 49 N
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:ND
Mailing Address - Zip Code:58523-6038
Mailing Address - Country:US
Mailing Address - Phone:701-873-7788
Mailing Address - Fax:701-873-4485
Practice Address - Street 1:111 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:ND
Practice Address - Zip Code:58530-0333
Practice Address - Country:US
Practice Address - Phone:701-794-8798
Practice Address - Fax:701-794-8885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-24
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND05912Medicaid
ND6103001OtherBCBS
NDN711254Medicare Oscar/Certification
ND351812Medicare Oscar/Certification