Provider Demographics
NPI:1619033917
Name:PRESENTATION MEDICAL CENTER
Entity Type:Organization
Organization Name:PRESENTATION MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-477-3161
Mailing Address - Street 1:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-0759
Mailing Address - Country:US
Mailing Address - Phone:701-477-3161
Mailing Address - Fax:701-477-5564
Practice Address - Street 1:213 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367-0759
Practice Address - Country:US
Practice Address - Phone:701-477-3161
Practice Address - Fax:701-477-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5045A275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND35Z316Medicare Oscar/Certification