Provider Demographics
NPI:1619061454
Name:ASHLEY MEDICAL CENTER
Entity Type:Organization
Organization Name:ASHLEY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LEPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-288-3433
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:ASHLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58413-0450
Mailing Address - Country:US
Mailing Address - Phone:701-288-3433
Mailing Address - Fax:
Practice Address - Street 1:612 CENTER AVE N
Practice Address - Street 2:
Practice Address - City:ASHLEY
Practice Address - State:ND
Practice Address - Zip Code:58413-7013
Practice Address - Country:US
Practice Address - Phone:701-288-3433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND7244OtherBLUE CROSS BLUE SHIELD
ND50606Medicaid
ND50606Medicaid