Basic Information
| Provider Information | |||||||||
| NPI: | 1578624136 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NELSON COUNTY HEALTH SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 307 | ||||||||
| Address2: | |||||||||
| City: | MCVILLE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582540307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013224347 | ||||||||
| FaxNumber: | 7013222244 | ||||||||
| Practice Location | |||||||||
| Address1: | 108 NORTH MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | MCVILLE | ||||||||
| State: | ND | ||||||||
| PostalCode: | 582540307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013224347 | ||||||||
| FaxNumber: | 7013222244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 05/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | BOWERSOX | ||||||||
| AuthorizedOfficialFirstName: | BRUCE | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7013224328 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | ND | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 016279 | 05 | ND | MEDICAID | 005005 | 05 | ND | MEDICAID | 004572 | 01 | ND | RURAL HEALTH CLINIC | OTHER | 301001 | 01 | ND | BLUE CROSS BLUE SHIELD | OTHER |