Provider Demographics
NPI:1912093725
Name:ST ANDREWS HOSPITAL
Entity type:Organization
Organization Name:ST ANDREWS HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-228-9300
Mailing Address - Street 1:316 OHMER ST
Mailing Address - Street 2:
Mailing Address - City:BOTTINEAU
Mailing Address - State:ND
Mailing Address - Zip Code:58318-1045
Mailing Address - Country:US
Mailing Address - Phone:701-228-9300
Mailing Address - Fax:701-228-9384
Practice Address - Street 1:316 OHMER ST
Practice Address - Street 2:
Practice Address - City:BOTTINEAU
Practice Address - State:ND
Practice Address - Zip Code:58318-1045
Practice Address - Country:US
Practice Address - Phone:701-228-9300
Practice Address - Fax:701-228-9384
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1912093725
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1904Medicaid
ND1904Medicaid