1699085720 NPI number — BIGHORN VALLEY HEALTH CENTER, INCORPORATED

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699085720 NPI number — BIGHORN VALLEY HEALTH CENTER, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BIGHORN VALLEY HEALTH CENTER, INCORPORATED
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:
1699085720
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 W LEWIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIVINGSTON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59047-3011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-823-6304
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 YELLOWSTONE AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST YELLOWSTONE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59758-9507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-656-9441
Provider Business Practice Location Address Fax Number:
406-646-9460
Provider Enumeration Date:
10/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MARK
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ANDREW
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
406-665-4103

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)





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