Provider Demographics
NPI:1134280860
Name:NELSON COUNTY HEALTH SYSTEM
Entity Type:Organization
Organization Name:NELSON COUNTY HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWERSOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-322-4328
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:MCVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58254-0367
Mailing Address - Country:US
Mailing Address - Phone:701-322-4328
Mailing Address - Fax:701-322-2250
Practice Address - Street 1:200 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MCVILLE
Practice Address - State:ND
Practice Address - Zip Code:58254-0367
Practice Address - Country:US
Practice Address - Phone:701-322-4328
Practice Address - Fax:701-322-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5035P282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND01039Medicaid
ND000356OtherBLUE CROSS BLUE SHIELD
ND351308Medicare ID - Type Unspecified