Provider Demographics
NPI:1063634210
Name:PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:PEMBINA COUNTY MEMORIAL HOSPITAL SWING BED
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LETEXIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-265-6228
Mailing Address - Street 1:301 MOUNTAIN ST E
Mailing Address - Street 2:P O BOX 380
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220-0380
Mailing Address - Country:US
Mailing Address - Phone:701-265-8461
Mailing Address - Fax:701-265-8752
Practice Address - Street 1:301 MOUNTAIN ST E
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-0380
Practice Address - Country:US
Practice Address - Phone:701-265-8461
Practice Address - Fax:701-265-8752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5009B275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND21379Medicaid
ND012443OtherND BLUE CROSS SB
ND001960Medicaid
ND35Z319Medicare Oscar/Certification