1265605398 NPI number — EASTERN MONTANA HEALTH COMPANY

Table of content: (NPI 1265605398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265605398 NPI number — EASTERN MONTANA HEALTH COMPANY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTERN MONTANA HEALTH COMPANY
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:
1265605398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
507 NORTH LINCOLN AVE
Provider Second Line Business Mailing Address:
BOX 489
Provider Business Mailing Address City Name:
BROADUS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59317-0489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-436-2651
Provider Business Mailing Address Fax Number:
406-436-2652

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 NORTH LINCOLN AVE
Provider Second Line Business Practice Location Address:
BOX 489
Provider Business Practice Location Address City Name:
BROADUS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59317-0489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-436-2651
Provider Business Practice Location Address Fax Number:
406-436-2652
Provider Enumeration Date:
04/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BIESHEUVEL
Authorized Official First Name:
LEROY
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PHYSICIAN'S ASSISTANT
Authorized Official Telephone Number:
406-436-2651

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  17 , 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: 90943 . This is a "BCBS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0720070 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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