Provider Demographics
NPI:1992014518
Name:PRESENTATION MEDICAL CENTER
Entity Type:Organization
Organization Name:PRESENTATION MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-477-1951
Mailing Address - Street 1:213 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-7153
Mailing Address - Country:US
Mailing Address - Phone:701-477-3161
Mailing Address - Fax:701-477-5564
Practice Address - Street 1:213 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367-7153
Practice Address - Country:US
Practice Address - Phone:701-477-3161
Practice Address - Fax:701-477-5564
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESENTATION MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-30
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5045A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND5202Medicaid
ND5202Medicaid