1548070394 NPI number — FORT PECK TRIBES

Table of content: (NPI 1548070394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548070394 NPI number — FORT PECK TRIBES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORT PECK TRIBES
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:
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:
1548070394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1027
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POPLAR
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59255-1027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-768-2202
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 15TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROCKTON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-768-3202
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2025

Additional Information

Authorized Official

Authorized Official Last Name:
FOUR BEAR
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
TRIBAL HEALTH SERVICE UNIT DIRECTOR
Authorized Official Telephone Number:
406-768-3491

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com