1790798387 NPI number — CENTRAL MONTANA MEDICAL FACILITIES, 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 1790798387 NPI number — CENTRAL MONTANA MEDICAL FACILITIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL MONTANA MEDICAL FACILITIES, 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:
CENTRAL MONTANA MEDICAL CENTER
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:
1790798387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 WENDELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTOWN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59457-2261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-535-7711
Provider Business Mailing Address Fax Number:
406-535-6392

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 WENDELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTOWN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59457-2261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-535-7711
Provider Business Practice Location Address Fax Number:
406-535-6392
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LANGBEHN
Authorized Official First Name:
CODY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
406-535-6200

Provider Taxonomy Codes

  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0410163 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00342 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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