1376617191 NPI number — SIDNEY HEALTH CENTER

Table of content: (NPI 1376617191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376617191 NPI number — SIDNEY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIDNEY HEALTH CENTER
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:
SIDNEY HEALTH CENTER 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:
1376617191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 14TH AVE SW
Provider Second Line Business Mailing Address:
STE 107
Provider Business Mailing Address City Name:
SIDNEY
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59270-3521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-488-2169
Provider Business Mailing Address Fax Number:
406-488-2149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 14TH AVE SW
Provider Second Line Business Practice Location Address:
STE 107
Provider Business Practice Location Address City Name:
SIDNEY
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59270-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-488-2169
Provider Business Practice Location Address Fax Number:
406-488-2149
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONTGOMERY
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR EXECUTIVE, FINANCE/CFO
Authorized Official Telephone Number:
406-488-2117

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000082342 . This is a "BLUE CROSS OF MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 15860 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com