Provider Demographics
NPI:1376584623
Name:WISHEK HOSPITAL-CLINIC ASSOCIATION
Entity Type:Organization
Organization Name:WISHEK HOSPITAL-CLINIC ASSOCIATION
Other - Org Name:RURAL HEALTH WISHEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING/INSURANCE CLERK
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROHWEDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-452-3207
Mailing Address - Street 1:PO BOX 647
Mailing Address - Street 2:
Mailing Address - City:WISHEK
Mailing Address - State:ND
Mailing Address - Zip Code:58495-0647
Mailing Address - Country:US
Mailing Address - Phone:701-452-3207
Mailing Address - Fax:701-452-2179
Practice Address - Street 1:1015 4TH AVE S
Practice Address - Street 2:
Practice Address - City:WISHEK
Practice Address - State:ND
Practice Address - Zip Code:58495
Practice Address - Country:US
Practice Address - Phone:701-452-2364
Practice Address - Fax:701-452-4276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5053A261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND00441001OtherBSND'S XOVERS FROM MCARE
ND14832Medicaid
ND5063Medicaid
ND35D0857336OtherRR MEDICARE CLIA # @ WSK
ND9365OtherBSND INST @ WISHEK
ND353408Medicare ID - Type Unspecified@ WISHEK
ND5063Medicaid