1528167905 NPI number — BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC

Table of content: (NPI 1528167905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528167905 NPI number — BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC
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:
1528167905
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
445 CENTENNIAL AVE
Provider Second Line Business Mailing Address:
SHERIDAN COMMUNITY HEALTH CENTER
Provider Business Mailing Address City Name:
BUTTE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59701-2870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-723-4075
Provider Business Mailing Address Fax Number:
406-496-6035

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
317 MADISON
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERIDAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59749-0245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-842-5103
Provider Business Practice Location Address Fax Number:
406-842-5110
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STERGAR
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
406-723-4075

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 95608222 . This is a "MT BREAST & CERVICAL PROG" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 0730028 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 63392 . This is a "BCBS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: CK5130 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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