Provider Demographics
NPI:1538297155
Name:UNION HOSPITAL SOCEITY OF MAYVILLE ND
Entity Type:Organization
Organization Name:UNION HOSPITAL SOCEITY OF MAYVILLE ND
Other - Org Name:UNION HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-788-3800
Mailing Address - Street 1:42 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58257-1506
Mailing Address - Country:US
Mailing Address - Phone:701-788-3800
Mailing Address - Fax:701-788-2145
Practice Address - Street 1:42 6TH AVE SE
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:ND
Practice Address - Zip Code:58257-1506
Practice Address - Country:US
Practice Address - Phone:701-788-3800
Practice Address - Fax:701-788-2145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND18443163WD0400X
ND5034P282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Multi-Specialty
Not Answered282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
21694Medicare UPIN