Provider Demographics
NPI:1376514240
Name:MERCY HOSPITAL OF DEVILS LAKE
Entity Type:Organization
Organization Name:MERCY HOSPITAL OF DEVILS LAKE
Other - Org Name:C.A.R.E. MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-662-2131
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-1195
Mailing Address - Country:US
Mailing Address - Phone:701-662-5056
Mailing Address - Fax:701-662-6113
Practice Address - Street 1:223 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301
Practice Address - Country:US
Practice Address - Phone:701-662-5056
Practice Address - Fax:701-662-6113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0172400002Medicare NSC