1144883984 NPI number — BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144883984 NPI number — BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC 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:
Provider Other Organization Name Type Code:
6
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:
1144883984
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 CENTENNIAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUTTE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59701-2870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-496-6000
Provider Business Mailing Address Fax Number:
406-496-6035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 E GLENDALE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DILLON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59725-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-988-0772
Provider Business Practice Location Address Fax Number:
406-988-0774
Provider Enumeration Date:
04/17/2019

Additional Information

Authorized Official

Authorized Official Last Name:
COX
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY DIRECTOR
Authorized Official Telephone Number:
406-496-6033

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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