NPIMap

Organization Active NPI

McKenzie County Healthcare Systems Inc

Doing business as McKenzie Health Center

  • Obstetrics & Gynecology Physician
  • Watford City, ND
National Provider Identifier
1689364598
Registry record updated Mar 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
MCKENZIE COUNTY HEALTHCARE SYSTEMS INC
Doing business as
McKenzie Health Center
Practice address
301 12TH St SE
Watford City, ND 58854-6722
Phone
(701) 842-3000
Fax
(701) 842-6248
NPI assigned
May 12, 2023
Last updated
Mar 19, 2024By 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 Mar 19, 2024

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X NU Primary
Pediatrics Physician 208000000X NU

Addresses

Primary practice location

301 12TH St SE
Watford City, ND 58854-6722

Mailing address

709 4TH Ave NE
Watford City, ND 58854-7628
Phone (701) 842-3000

Other names 1

  • McKenzie Health Center 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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D2284879McKenzie Health Center301 12TH St SE, Watford City, ND 58854Certificate of waiverJun 28, 2027

National Provider Directory

National Provider Directory
Part of
McKenzie County Healthcare

Locations

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

Practitioners & affiliated clinicians

Practitioners 46

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 46

NPI Registry JSON

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

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710806400000",
    "number": "1689364598",
    "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": "701-842-3000",
            "fax_number": "701-842-4025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 12TH ST SE",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588546722",
            "telephone_number": "701-842-3000",
            "fax_number": "701-842-6248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKENZIE COUNTY HEALTHCARE SYSTEMS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCKENZIE COUNTY HEALTHCARE SYSTEMS INC",
        "enumeration_date": "2023-05-12",
        "last_updated": "2024-03-19",
        "certification_date": "2023-09-08",
        "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": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McKenzie Health Center",
            "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 Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.