Provider Demographics
NPI:1336196039
Name:JACOBSON MEMORIAL HOSPITAL CARE CENTER
Entity Type:Organization
Organization Name:JACOBSON MEMORIAL HOSPITAL CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:OPDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-584-2792
Mailing Address - Street 1:601 EAST ST N
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:ND
Mailing Address - Zip Code:58533-7105
Mailing Address - Country:US
Mailing Address - Phone:701-584-2792
Mailing Address - Fax:
Practice Address - Street 1:601 EAST ST N
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:ND
Practice Address - Zip Code:58533-7105
Practice Address - Country:US
Practice Address - Phone:701-584-2792
Practice Address - Fax:701-584-3348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5014P282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1014Medicaid
ND002949OtherBCBS SWINGBED
ND000539OtherBCBS HOSPITAL
ND1919Medicaid
ND002949OtherBCBS SWINGBED
ND1014Medicaid