1376637470 NPI number — MISSOULA COMMUNITY HEALTH SERVICES, INC.

Table of content: (NPI 1376637470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376637470 NPI number — MISSOULA COMMUNITY HEALTH SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSOULA COMMUNITY HEALTH SERVICES, 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:
1376637470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 66
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUPERIOR
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59872
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-822-4841
Provider Business Mailing Address Fax Number:
406-822-4963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1208 6TH AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUPERIOR
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59872
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-822-4841
Provider Business Practice Location Address Fax Number:
406-822-4963
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCNEECE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
406-822-4841

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: 11203 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , 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: 9989941 . This is a "PASSPORT PROVIDER NUMBER" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 720460 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000066882 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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