1447353008 NPI number — COUNTY OF DAWSON

Table of content: (NPI 1447353008)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447353008 NPI number — COUNTY OF DAWSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF DAWSON
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:
DAWSON COUNTY HEALTH DEPT
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:
1447353008
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 W BELL 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:
59330-1616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-377-5213
Provider Business Mailing Address Fax Number:
406-377-2022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 W BELL 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:
59330-1616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-377-5213
Provider Business Practice Location Address Fax Number:
406-377-2022
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MURPHREE
Authorized Official First Name:
LAUREEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
406-377-5213

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  NA , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 99765 . This is a "DR. LEAL -BL. CROSS #" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 290224 . This is a "TCM #" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 670475 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 31278 . This is a "BLUE CHIP PROVIDER #" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 7774712 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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