Provider Demographics
NPI:1871691519
Name:JACOBSON MEMORIAL HOSPITAL CARE CENTER
Entity type:Organization
Organization Name:JACOBSON MEMORIAL HOSPITAL CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:OPDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-584-2792
Mailing Address - Street 1:601 EAST ST N
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:ND
Mailing Address - Zip Code:58533-7105
Mailing Address - Country:US
Mailing Address - Phone:701-584-2792
Mailing Address - Fax:701-584-3348
Practice Address - Street 1:603 EAST ST N
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:ND
Practice Address - Zip Code:58533-7105
Practice Address - Country:US
Practice Address - Phone:701-584-2792
Practice Address - Fax:701-584-3348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JACOBSON MEMORIAL HOSPITAL CARE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND015169Medicaid
ND06043002OtherBCBS-ELGIN RHC
NDN711235Medicare PIN
ND06043002OtherBCBS-ELGIN RHC