Provider Demographics
NPI:1184641110
Name:ST JOSEPH'S HOSPITAL AND HEALTH CENTER
Entity Type:Organization
Organization Name:ST JOSEPH'S HOSPITAL AND HEALTH CENTER
Other - Org Name:KILLDEER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-456-4277
Mailing Address - Street 1:7360 SOLUTIONS CENTER
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-7003
Mailing Address - Country:US
Mailing Address - Phone:701-456-4000
Mailing Address - Fax:
Practice Address - Street 1:150 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:KILLDEER
Practice Address - State:ND
Practice Address - Zip Code:58640-0668
Practice Address - Country:US
Practice Address - Phone:701-764-5822
Practice Address - Fax:701-764-5304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5054A261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND353976Medicare Oscar/Certification