1740464916 NPI number — MCCONE COUNTY HEALTH CENTER INC

Table of content: (NPI 1740464916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740464916 NPI number — MCCONE COUNTY HEALTH CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCONE COUNTY HEALTH CENTER 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:
1740464916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CIRCLE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59215-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-485-2063
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
605 SULLIVAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CIRCLE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59215-0278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-485-2063
Provider Business Practice Location Address Fax Number:
406-485-2435
Provider Enumeration Date:
12/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARDNER
Authorized Official First Name:
JACQUE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CLINIC MANAGER
Authorized Official Telephone Number:
406-485-2063

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  40 , registered in the state of MT ; 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