Organization
COOPERSTOWN MEDICAL CENTER
Active
Parent organization
COOPERSTOWN MEDICAL CENTER
Other names
Cooperstown Medical Center Swing Bed, Dakota Regional Medical Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
COOPERSTOWN MEDICAL CENTER
Authorized official
KELLEY SHAWN (ADMIN ASSIST/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) 786-1700
(701) 786-7121
Taxonomy
Speciality
Code
Description
License number
State
275N00000X
Medicare Defined Swing Bed Hospital Unit
Primary
5001P
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1912
—
ND
01
—
2774
BLUE CROSS BLUE SHIELD
ND
Enumeration date
09/29/2006
Last updated
08/29/2023
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