1215040449 NPI number — GLENDIVE MEDICAL CENTER, INC

Table of content: (NPI 1215040449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215040449 NPI number — GLENDIVE MEDICAL CENTER, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GLENDIVE MEDICAL CENTER, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GABERT CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215040449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
107 DILWORTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDIVE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59330-2053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-345-8901
Provider Business Mailing Address Fax Number:
406-345-8908

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
107 DILWORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDIVE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59330-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-345-8901
Provider Business Practice Location Address Fax Number:
406-345-8908
Provider Enumeration Date:
08/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF FINANCIAL SERVICES
Authorized Official Telephone Number:
406-345-8924

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0720562 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8882 . This is a "BLUE CROSS RHC" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".