Provider Demographics
NPI:1376651463
Name:JACOBSON MEMORIAL HOSPITAL CARE CENTER
Entity Type:Organization
Organization Name:JACOBSON MEMORIAL HOSPITAL CARE CENTER
Other - Org Name:HEBRON COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:OPDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-584-2792
Mailing Address - Street 1:601 EAST ST N
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:ND
Mailing Address - Zip Code:58533-7105
Mailing Address - Country:US
Mailing Address - Phone:701-584-2792
Mailing Address - Fax:701-584-3348
Practice Address - Street 1:811 MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:ND
Practice Address - Zip Code:58638
Practice Address - Country:US
Practice Address - Phone:701-878-4250
Practice Address - Fax:701-878-4346
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACOBSON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-28
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND05170Medicaid
ND06043001OtherBCBS - HEBRON RHC
ND353441Medicare ID - Type UnspecifiedHEBRON RHC