Provider Demographics
NPI:1083706105
Name:HILLSBORO MEDICAL CENTER
Entity Type:Organization
Organization Name:HILLSBORO MEDICAL CENTER
Other - Org Name:HILLSBORO MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAC
Authorized Official - Middle Name:
Authorized Official - Last Name:MCTAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-636-3201
Mailing Address - Street 1:12 3RD ST SE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:ND
Mailing Address - Zip Code:58045-4840
Mailing Address - Country:US
Mailing Address - Phone:701-636-3219
Mailing Address - Fax:701-636-3206
Practice Address - Street 1:12 3RD ST SE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:ND
Practice Address - Zip Code:58045-4840
Practice Address - Country:US
Practice Address - Phone:701-636-3219
Practice Address - Fax:701-636-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND56341600000X
ND5026PND341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND351329Medicare Oscar/Certification