1679693584 NPI number — BLACKFEET COMMUNITY HOSPITAL

Table of content: (NPI 1679693584)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679693584 NPI number — BLACKFEET COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLACKFEET COMMUNITY HOSPITAL
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:
INDIAN HEALTH SERVICE
Provider Other Organization Name Type Code:
5
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:
1679693584
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 760
Provider Second Line Business Mailing Address:
HOSPITAL CIRCLE
Provider Business Mailing Address City Name:
BROWNING
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59417-0760
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-338-6231
Provider Business Mailing Address Fax Number:
406-338-6347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 HOSPITAL CIRLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNING
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59417-0760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-338-6231
Provider Business Practice Location Address Fax Number:
406-338-6347
Provider Enumeration Date:
04/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MAGEE
Authorized Official First Name:
MYRA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CASE MANAGER
Authorized Official Telephone Number:
406-338-6231

Provider Taxonomy Codes

  • Taxonomy code: 282NR1301X , with the licence number:  19625 , 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)