Provider Demographics
NPI:1851335830
Name:ASHLEY MEDICAL CENTER
Entity Type:Organization
Organization Name:ASHLEY MEDICAL CENTER
Other - Org Name:AMC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOEFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-288-3433
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:612 CENTER AVE N
Mailing Address - City:ASHLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58413-0450
Mailing Address - Country:US
Mailing Address - Phone:701-288-3448
Mailing Address - Fax:701-288-3213
Practice Address - Street 1:612 CENTER AVE N
Practice Address - Street 2:
Practice Address - City:ASHLEY
Practice Address - State:ND
Practice Address - Zip Code:58413-7013
Practice Address - Country:US
Practice Address - Phone:701-288-3448
Practice Address - Fax:701-288-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND16578Medicaid
ND16578Medicaid