Provider Demographics
NPI:1275802316
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 WALK-IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REED
Authorized Official - Middle Name:
Authorized Official - Last Name:REYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-456-4390
Mailing Address - Street 1:227 16TH ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-4675
Mailing Address - Country:US
Mailing Address - Phone:701-227-7900
Mailing Address - Fax:701-227-7985
Practice Address - Street 1:227 16TH ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-4675
Practice Address - Country:US
Practice Address - Phone:701-227-7900
Practice Address - Fax:701-227-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12842Medicaid
ND12842Medicaid