1568759249 NPI number — LINCOLN COUNTY COMMUNITY HEALTH CENTER

Table of content: (NPI 1568759249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568759249 NPI number — LINCOLN COUNTY COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINCOLN COUNTY COMMUNITY HEALTH CENTER
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:
1568759249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 E 2ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBBY
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59923-2010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-283-6900
Provider Business Mailing Address Fax Number:
406-293-6622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 DEWEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-297-7220
Provider Business Practice Location Address Fax Number:
406-297-7221
Provider Enumeration Date:
07/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CLEMONS
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
406-283-6919

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com