Provider Demographics
NPI:1689735235
Name:NELSON COUNTY HEALTH SYSTEM
Entity Type:Organization
Organization Name:NELSON COUNTY HEALTH SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWERSOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-322-4328
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:MCVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58254-0367
Mailing Address - Country:US
Mailing Address - Phone:701-322-4328
Mailing Address - Fax:701-322-2250
Practice Address - Street 1:200 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MCVILLE
Practice Address - State:ND
Practice Address - Zip Code:58254-0367
Practice Address - Country:US
Practice Address - Phone:701-322-4328
Practice Address - Fax:701-322-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5035275N00000X
282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND003343OtherBLUE CROSS BLUE SHIELD
ND01926Medicaid
ND35Z308Medicare ID - Type Unspecified