Provider Demographics
NPI:1033634712
Name:GARRISON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:GARRISON MEMORIAL HOSPITAL
Other - Org Name:GARRISON FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TOD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAEBER
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:701-463-6505
Mailing Address - Street 1:437 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:ND
Mailing Address - Zip Code:58540-7235
Mailing Address - Country:US
Mailing Address - Phone:701-463-2275
Mailing Address - Fax:
Practice Address - Street 1:407 3RD AVE SE
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:ND
Practice Address - Zip Code:58540-7235
Practice Address - Country:US
Practice Address - Phone:701-463-2275
Practice Address - Fax:701-463-6543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND9555OtherBLUE CROSS BLUE SHIELD
ND1461833Medicaid