1235204538 NPI number — WHEATLAND MEMORIAL HEALTHCARE

Table of content: (NPI 1235204538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235204538 NPI number — WHEATLAND MEMORIAL HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WHEATLAND MEMORIAL HEALTHCARE
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:
BAIR MEMORIAL CLINIC
Provider Other Organization Name Type Code:
5
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:
1235204538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2911
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLOWTON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59036-2911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-632-4351
Provider Business Mailing Address Fax Number:
406-632-3172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 3RD ST NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLOWTON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-632-4351
Provider Business Practice Location Address Fax Number:
406-632-3172
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DONOVAN
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
406-632-3115

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  10879 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0720278 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com