Provider Demographics
NPI:1205244944
Name:PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LETEXIER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:701-265-6228
Mailing Address - Street 1:301 MOUNTAIN ST E
Mailing Address - Street 2:PO BOX 380
Mailing Address - City:CAVALIER
Mailing Address - State:ND
Mailing Address - Zip Code:58220-4015
Mailing Address - Country:US
Mailing Address - Phone:701-265-6307
Mailing Address - Fax:701-265-6373
Practice Address - Street 1:301 MOUNTAIN ST E
Practice Address - Street 2:
Practice Address - City:CAVALIER
Practice Address - State:ND
Practice Address - Zip Code:58220-4015
Practice Address - Country:US
Practice Address - Phone:701-265-6307
Practice Address - Fax:701-265-6373
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEMBINA COUNTY MEMORIAL HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDPAC0563363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty