Provider Demographics
NPI:1184117293
Name:MERCY HOSPITAL OF DEVILS LAKE
Entity type:Organization
Organization Name:MERCY HOSPITAL OF DEVILS LAKE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LANKOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-662-2131
Mailing Address - Street 1:425 COLLEGE DR S STE 14
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-3537
Mailing Address - Country:US
Mailing Address - Phone:701-662-8662
Mailing Address - Fax:
Practice Address - Street 1:425 COLLEGE DR S STE 14
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301
Practice Address - Country:US
Practice Address - Phone:701-662-8662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL OF DEVILS LAKE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-13
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5012261QC0050X, 261QM1300X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1475134Medicaid