Provider Demographics
NPI:1205916087
Name:UNION HOSPITAL SOCIETY OF MAYVILLE ND
Entity type:Organization
Organization Name:UNION HOSPITAL SOCIETY OF MAYVILLE ND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-788-3800
Mailing Address - Street 1:42 6TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:ND
Mailing Address - Zip Code:58257-1506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:407 WASHINGTON AVE E
Practice Address - Street 2:
Practice Address - City:FINLEY
Practice Address - State:ND
Practice Address - Zip Code:58230
Practice Address - Country:US
Practice Address - Phone:701-524-1005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND0016702Medicaid
70729OtherBC BS ND X-RAY
ND00088001OtherBC BS ND
70722OtherBC BS LAB
70722OtherBC BS LAB
NDN70722Medicare PIN
70729OtherBC BS ND X-RAY
NDN70722Medicare Oscar/Certification
NDN70729Medicare PIN
NDN1000088Medicare PIN