Provider Demographics
NPI:1942465364
Name:ASHLEY MEDICAL CENTER
Entity Type:Organization
Organization Name:ASHLEY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
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:P O BOX 450
Mailing Address - Street 2:612 CENTER AVE NO
Mailing Address - City:ASHLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58413-0450
Mailing Address - Country:US
Mailing Address - Phone:701-288-3433
Mailing Address - Fax:701-288-3938
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:701-288-3433
Practice Address - Fax:701-288-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5001P261QC0050X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND10215OtherBLUE SHIELD