Provider Demographics
NPI:1073745279
Name:ST. JOSEPH'S HOSPITAL AND HEALTH CENTER
Entity Type:Organization
Organization Name:ST. JOSEPH'S HOSPITAL AND HEALTH CENTER
Other - Org Name:ST. JOSEPH'S SURGICAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REED
Authorized Official - Middle Name:E
Authorized Official - Last Name:REYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-465-4000
Mailing Address - Street 1:45 8TH ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3951
Mailing Address - Country:US
Mailing Address - Phone:701-456-4000
Mailing Address - Fax:
Practice Address - Street 1:45 8TH ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3951
Practice Address - Country:US
Practice Address - Phone:701-456-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5054A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11093Medicaid
NDN1000095Medicare Oscar/Certification
NDN1000095Medicare PIN