Provider Demographics
NPI:1356449136
Name:NORTHWOOD DEACONESS HEALTH CENTER
Entity Type:Organization
Organization Name:NORTHWOOD DEACONESS HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTONSON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:701-587-6060
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58267-0190
Mailing Address - Country:US
Mailing Address - Phone:701-587-6060
Mailing Address - Fax:701-587-6492
Practice Address - Street 1:4 NORTH PARK ST
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:ND
Practice Address - Zip Code:58267-0190
Practice Address - Country:US
Practice Address - Phone:701-587-6060
Practice Address - Fax:701-587-6492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5040P282NC0060X
ND35D0684526291U00000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No291U00000XLaboratoriesClinical Medical Laboratory
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND11827Medicaid
1000064OtherMEDICARE PART B
MN623348100Medicaid
ND0174OtherBCBS
NDD01045Medicaid
ND11827Medicaid
ND351312Medicare Oscar/Certification