Provider Demographics
NPI:1972698975
Name:MERCY HOSPITAL OF VALLEY CITY
Entity Type:Organization
Organization Name:MERCY HOSPITAL OF VALLEY CITY
Other - Org Name:CHI MERCY HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-845-6400
Mailing Address - Street 1:570 CHAUTAUQUA BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-3145
Mailing Address - Country:US
Mailing Address - Phone:701-845-6400
Mailing Address - Fax:701-845-6413
Practice Address - Street 1:570 CHAUTAUQUA BOULEVARD
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3145
Practice Address - Country:US
Practice Address - Phone:701-845-6400
Practice Address - Fax:701-845-6413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5050A207P00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND17871Medicaid
ND17871Medicaid