Provider Demographics
NPI:1477549111
Name:MERCY HOSPITAL OF VALLEY CITY
Entity type:Organization
Organization Name:MERCY HOSPITAL OF VALLEY CITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
ND5050261QC0050X
ND5050A282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND5050AOtherHOSPITAL LICENSE
ND001056Medicaid
ND20388Medicaid
ND351324Medicare PIN
ND5050AOtherHOSPITAL LICENSE