Provider Demographics
NPI:1689364598
Name:MCKENZIE COUNTY HEALTHCARE SYSTEMS INC
Entity Type:Organization
Organization Name:MCKENZIE COUNTY HEALTHCARE SYSTEMS INC
Other - Org Name:MCKENZIE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:EDIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-444-8609
Mailing Address - Street 1:709 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WATFORD CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58854-7628
Mailing Address - Country:US
Mailing Address - Phone:701-842-3000
Mailing Address - Fax:701-842-4025
Practice Address - Street 1:301 12TH ST SE
Practice Address - Street 2:
Practice Address - City:WATFORD CITY
Practice Address - State:ND
Practice Address - Zip Code:58854-6722
Practice Address - Country:US
Practice Address - Phone:701-842-3000
Practice Address - Fax:701-842-6248
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCKENZIE COUNTY HEALTHCARE SYSTEMS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-12
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty