Provider Demographics
NPI:1750328662
Name:CAVALIER COUNTY MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:CAVALIER COUNTY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:CAVALIER COUNTY MEMORIAL HOSPITAL & CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:
Authorized Official - Last Name:STANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-256-6180
Mailing Address - Street 1:909 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LANGDON
Mailing Address - State:ND
Mailing Address - Zip Code:58249-2407
Mailing Address - Country:US
Mailing Address - Phone:701-256-6100
Mailing Address - Fax:701-256-2170
Practice Address - Street 1:909 2ND ST
Practice Address - Street 2:
Practice Address - City:LANGDON
Practice Address - State:ND
Practice Address - Zip Code:58249-2407
Practice Address - Country:US
Practice Address - Phone:701-256-6100
Practice Address - Fax:701-256-2170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5029282NC0060X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND5029AOtherSTATE LICENSE NUMBER
ND1454323Medicaid
ND6905120001Medicare NSC