Organization
COOPERSTOWN MEDICAL CENTER
Active
Parent organization
COOPERSTOWN MEDICAL CENTER
Other names
Dakota Regional Medical Center, Cooperstown Medical Center DME
Organization subpart
Yes
Provider details
NPI number
Legal business name
COOPERSTOWN MEDICAL CENTER
Authorized official
KELLEY SHAWN (ADMIN ASSISTANT/CREDENTIALING)
(701) 786-1709
Entity
Organization
Contact information
Practice address
107 12TH ST S, COOPERSTOWN, ND 58425-4501
(701) 786-1700
(701) 786-7121
Mailing address
107 12TH ST S, COOPERSTOWN, ND 58425-4501
(701) 789-1700
(701) 786-7121
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1009
—
ND
01
—
21295
BLUE CROSS/BLUE SHEILD OF
ND
01
—
23723
BLUE CROSS/BLUE SHIELD OF
ND
01
—
24856
BLUE CROSS/BLUE SHIELD OF
ND
05
—
30095
—
ND
01
—
489
BLUE CROSS/BLUE SHIELD OF
ND
Enumeration date
01/08/2008
Last updated
08/29/2023
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