NPIMap

Organization Active NPI

McKenzie County Healthcare Systems Inc

Doing business as MCHS-Clinic

  • Clinic/Center
  • Watford City, ND
National Provider Identifier
1063420495
Registry record updated Jun 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MCKENZIE COUNTY HEALTHCARE SYSTEMS INC
Doing business as
MCHS-Clinic
Practice address
709 4TH Ave NE
Watford City, ND 58854-7628
Phone
(701) 842-3771
Fax
(701) 842-4025
NPI assigned
Aug 3, 2006
Last updated
Jun 9, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MCKENZIE COUNTY HEALTHCARE SYSTEMS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Peter Edis
Title
Ceo
Phone
(701) 444-8609

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

709 4TH Ave NE
Watford City, ND 58854-7628

Mailing address

709 4TH Ave NE
Watford City, ND 58854-7628
Phone (701) 842-3771

Other identifiers 4

IdentifierTypeStateIssuer
6340001OtherNDBLUE CROSS BLUE SHIELD
13173MedicaidND
720528MedicaidMT
MD421NDMedicaidAL

Other names 1

  • MCHS-Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040817000016 ND Part B Supplier - Clinic/Group Practice 5890768006 Receives reassigned benefits from 115 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Minot, ND; Williston, ND; Watford City, ND

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
McKenzie County Healthcare

Locations

1002 18th Ave SE
Ste C
Minot, ND 58701
Phone (701) 857-6010

709 4th Ave NE
Watford City, ND 58854
Phone (701) 444-2331

1542 16th St W
Ste 300
Williston, ND 58801
Phone (701) 572-2470

Practitioners & affiliated clinicians

Practitioners 68

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 68

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686268800000",
    "number": "1063420495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 4TH AVE NE",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588547628",
            "telephone_number": "701-842-3771",
            "fax_number": "701-842-4025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 4TH AVE NE",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588547628",
            "telephone_number": "701-842-3771",
            "fax_number": "701-842-4025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKENZIE COUNTY HEALTHCARE SYSTEMS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCKENZIE COUNTY HEALTHCARE SYSTEMS INC",
        "enumeration_date": "2006-08-03",
        "last_updated": "2023-06-09",
        "certification_date": "2023-04-10",
        "status": "A",
        "authorized_official_last_name": "EDIS",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-444-8609"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "6340001",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13173",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "720528",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MD421ND",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MCHS-Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MCHS-Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watford City, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.