Provider Demographics
NPI:1700965696
Name:HAZEN MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:HAZEN MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:SAKAKAWEA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDBILLIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-748-2225
Mailing Address - Street 1:510 8TH AVENUE NE
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545
Mailing Address - Country:US
Mailing Address - Phone:701-748-2225
Mailing Address - Fax:701-639-4343
Practice Address - Street 1:510 8TH AVE NE
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:ND
Practice Address - Zip Code:58545-4637
Practice Address - Country:US
Practice Address - Phone:701-748-2225
Practice Address - Fax:701-639-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5024A282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2766OtherBCBS
ND14525Medicaid
ND009886OtherBCBS HOSPICE NUMBER
ND000471OtherBCBS NUMBER
ND009431OtherBCBS HH NUMBER
ND00340001OtherBCBS CLINIC
ND59258Medicaid
NDD01027Medicaid
ND50199Medicaid
ND009886OtherBCBS HOSPICE NUMBER
ND351310Medicare PIN
ND2766OtherBCBS
ND50199Medicaid
ND009431OtherBCBS HH NUMBER
NDN6266Medicare ID - Type UnspecifiedMEDICARE CLINIC