Provider Demographics
NPI:1851317317
Name:LINTON HOSPITAL
Entity Type:Organization
Organization Name:LINTON HOSPITAL
Other - Org Name:HAZELTON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-254-4511
Mailing Address - Street 1:343 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HAZELTON
Mailing Address - State:ND
Mailing Address - Zip Code:58544
Mailing Address - Country:US
Mailing Address - Phone:701-782-4338
Mailing Address - Fax:
Practice Address - Street 1:343 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAZELTON
Practice Address - State:ND
Practice Address - Zip Code:58544
Practice Address - Country:US
Practice Address - Phone:701-782-4338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LINTON HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-15
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN70885Medicare ID - Type Unspecified