1477734416 NPI number — POWELL COUNTY HEALTH DEPARTMENT

Table of content: (NPI 1477734416)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477734416 NPI number — POWELL COUNTY HEALTH DEPARTMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
POWELL COUNTY HEALTH DEPARTMENT
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:
1477734416
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 716
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEER LODGE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59722-0716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-846-2420
Provider Business Mailing Address Fax Number:
406-846-3436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 MILWAUKEE AVE STE 23
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEER LODGE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59722-1035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-846-2420
Provider Business Practice Location Address Fax Number:
406-846-3436
Provider Enumeration Date:
11/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NELSON
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
PUBLIC HEALTH DIRECTOR
Authorized Official Telephone Number:
406-846-2420

Provider Taxonomy Codes

  • Taxonomy code: 261QF0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0350051 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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