Provider Demographics
NPI:1760542500
Name:PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LETEXIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-265-6228
Mailing Address - Street 1:301 MOUNTAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220
Mailing Address - Country:US
Mailing Address - Phone:701-265-8473
Mailing Address - Fax:701-265-6269
Practice Address - Street 1:301 MOUNTAIN ST E
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220
Practice Address - Country:US
Practice Address - Phone:701-265-8473
Practice Address - Fax:701-265-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5009B282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12113Medicaid
ND351319Medicare ID - Type UnspecifiedMEDICARE BILLING
ND12113Medicaid