1003939190 NPI number — PIONEER MEDICAL CENTER

Table of content: (NPI 1003939190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003939190 NPI number — PIONEER MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIONEER MEDICAL 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'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:
1003939190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1228
Provider Second Line Business Mailing Address:
301 WEST 7TH AVENUE, SUITE CAH
Provider Business Mailing Address City Name:
BIG TIMBER
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59011-1228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-932-4603
Provider Business Mailing Address Fax Number:
406-932-5468

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIG TIMBER
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59011-7893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-932-4603
Provider Business Practice Location Address Fax Number:
406-932-5468
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PETERSON
Authorized Official First Name:
IAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
406-932-4603

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 10783 , 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)

  • Identifier: 60172 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 15731 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0411749 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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