1659475846 NPI number — MARCUS DALY MEMORIAL HOSPITAL CORPORATION

Table of content: (NPI 1659475846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659475846 NPI number — MARCUS DALY MEMORIAL HOSPITAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARCUS DALY MEMORIAL HOSPITAL CORPORATION
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:
BITTERROOT HEALTH-DALY HOSPITAL
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:
1659475846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 WESTWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59840-2395
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-363-2211
Provider Business Mailing Address Fax Number:
406-363-6536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 WESTWOOD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMILTON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59840-2395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-363-2211
Provider Business Practice Location Address Fax Number:
406-363-6536
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BISHOP
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
406-363-2211

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X , with the licence number:  10168 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 11372 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 11372 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X , with the licence number: 12139 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 002197100 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4103018 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7077530 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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