Provider Demographics
NPI:1790751170
Name:MERCY HOSPITAL OF DEVILS LAKE
Entity Type:Organization
Organization Name:MERCY HOSPITAL OF DEVILS LAKE
Other - Org Name:CHI ST ALEXIUS HEALTH DEVILS LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERATIONAL FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:SARGENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-237-8064
Mailing Address - Street 1:1031 7TH ST NE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2798
Mailing Address - Country:US
Mailing Address - Phone:701-662-2131
Mailing Address - Fax:701-662-9651
Practice Address - Street 1:1031 7TH ST NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2798
Practice Address - Country:US
Practice Address - Phone:701-662-2131
Practice Address - Fax:701-662-9651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1462607Medicaid
ND076001OtherBLUE CROSS GROUP NUMBER
ND1462607Medicaid