Provider Demographics
NPI:1457313819
Name:MERCY HOSPITAL
Entity Type:Organization
Organization Name:MERCY HOSPITAL
Other - Org Name:HILINE MEDICAL EQUIPMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:HEUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-845-6400
Mailing Address - Street 1:570 CHAUTAUQUA BLVD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:ND
Mailing Address - Zip Code:58072-3145
Mailing Address - Country:US
Mailing Address - Phone:701-845-6400
Mailing Address - Fax:701-845-6413
Practice Address - Street 1:570 CHAUTAUQUA BLVD
Practice Address - Street 2:
Practice Address - City:VALLEY CITY
Practice Address - State:ND
Practice Address - Zip Code:58072-3145
Practice Address - Country:US
Practice Address - Phone:701-845-6400
Practice Address - Fax:701-845-6413
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MERCY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-03
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND56483Medicaid
0429640001Medicare ID - Type Unspecified