1992786784 NPI number — EASTERN MONTANA COMMUNITY MENTAL HEALTH CENTER

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992786784 NPI number — EASTERN MONTANA COMMUNITY MENTAL HEALTH CENTER

Employer Identification Number (EIN):

Provider Organization Name:

EASTERN MONTANA COMMUNITY MENTAL 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 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:

1992786784

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

07/30/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 1530

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MILES CITY

Provider Business Mailing Address State Name:

MT

Provider Business Mailing Address Postal Code:

59301-1530

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

406-234-0234

Provider Business Mailing Address Fax Number:

406-234-0235

Provider First Line Business Practice Location Address:

2508 WILSON ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MILES CITY

Provider Business Practice Location Address State Name:

MT

Provider Business Practice Location Address Postal Code:

59301-5000

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

406-234-1687

Provider Business Practice Location Address Fax Number:

406-234-1698

Provider Enumeration Date:

11/08/2005

Authorized Official Last Name:

BEASON

Authorized Official First Name:

KATHY

Authorized Official Middle Name:

K

Authorized Official Title or Position:

CHIEF INFORMATION OFFICER

Authorized Official Telephone Number:

406-234-0234

• Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QM0801X , with the licence number: 10392 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 0439212 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 0491470 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 0502418 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 0320112 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 0255527 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 0290147 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 75031 . This is a "BS/BS PROVIDER #" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
• Identifier: 0402142 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".