Provider Demographics
NPI:1033292875
Name:LISBON AREA HEALTH SERVICES
Entity Type:Organization
Organization Name:LISBON AREA HEALTH SERVICES
Other - Org Name:CHI LISBON HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:701-683-6419
Mailing Address - Street 1:905 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ND
Mailing Address - Zip Code:58054-4334
Mailing Address - Country:US
Mailing Address - Phone:701-683-6400
Mailing Address - Fax:701-683-4345
Practice Address - Street 1:905 MAIN STREET
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ND
Practice Address - Zip Code:58054-0353
Practice Address - Country:US
Practice Address - Phone:701-683-6400
Practice Address - Fax:701-683-4345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5031B275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1463373Medicaid
ND35Z311Medicaid
ND35Z311Medicare ID - Type Unspecified
ND01962Medicaid