Provider Demographics
NPI:1689842478
Name:COMMUNITY MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:COMMUNITY MEMORIAL HOSPITAL
Other - Org Name:ST. ALEXIUS MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-448-2331
Mailing Address - Street 1:220 5TH AVE W
Mailing Address - Street 2:
Mailing Address - City:TURTLE LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58575-0280
Mailing Address - Country:US
Mailing Address - Phone:701-448-2331
Mailing Address - Fax:701-448-2441
Practice Address - Street 1:122 2ND ST. EAST
Practice Address - Street 2:
Practice Address - City:MCCLUSKY
Practice Address - State:ND
Practice Address - Zip Code:58463-0618
Practice Address - Country:US
Practice Address - Phone:701-363-2296
Practice Address - Fax:701-363-2762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center