1063677417 NPI number — SHIELDS VALLEY HEALTH CENTER, 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 1063677417 NPI number — SHIELDS VALLEY HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIELDS VALLEY 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:
1063677417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
309 ELLIOTT STREET NORTH
Provider Second Line Business Mailing Address:
PO BOX 347
Provider Business Mailing Address City Name:
WILSALL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59086-0347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-578-2580
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 ELLIOTT STREET NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILSALL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59086-0347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-578-2580
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCOTT
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
FRANCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
406-578-2512

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  NONE REQUIRED , 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)





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