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COAL COUNTRY COMMUNITY HEALTH CENTER NPI 1407235575


NPI Information

NPI: 1407235575
Provider Name: COAL COUNTRY COMMUNITY HEALTH CENTER
Classification: Clinic/Center - 261QF0400X
Entity Type: Organization

Specialization: Federally Qualified Health Center (FQHC)

CLIA Number: 35D2285545

Address:
150 CENTRAL AVE N
KILLDEER, ND
ZIP 58640
Phone: (701) 764-5822
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COAL COUNTRY COMMUNITY HEALTH CENTER is a federally qualified health center (fqhc) clinic center in Killdeer, ND. COAL COUNTRY COMMUNITY HEALTH CENTER NPI is 1407235575. The provider is registered as an organization entity type.

The provider's business location address is:

150 CENTRAL AVE N
KILLDEER, ND
ZIP 58640-018
Phone: (701) 764-5822

The provider's authorized official is Darrold Bertsch .
The authorized official title is Ceo and has the following contact phone number (701) 873-4445.

The CLIA number assigned to this NPI record is 35D2285545 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/22/2015 and was last updated on 12/8/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QF0400XClinic/CenterFederally Qualified Health Center (FQHC)Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11464996MEDICAIDNORTH DAKOTA
2N711254MEDICARE OSCAR/CERTIFICATIONNORTH DAKOTA
3351818MEDICARE OSCAR/CERTIFICATIONNORTH DAKOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.