Organization
MERCY MEDICAL CENTER
Active
Organization
MERCY MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRY S. MONSON (VP FINANCE CFO)
(701) 774-7401
Entity
Organization
Contact information
Practice address
1301 15TH AVE W, WILLISTON, ND 58801-3821
(701) 774-7401
(701) 774-7479
Mailing address
1301 15TH AVE W, WILLISTON, ND 58801-3821
(701) 774-7401
(701) 774-7479
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
5052A
ND
1041C0700X
Clinical Social Worker
5052A
ND
2084P0800X
Psychiatry Physician
Primary
5052A
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11684
—
ND
01
—
711002
BLUE SHIELD OF ND
ND
Enumeration date
03/09/2007
Last updated
06/23/2008
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