| |
332 Leavitt Avenue Jordan MT 59337-0389 | |
(406) 557-2500 | |
(406) 557-2951 |
Full Name | |
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Speciality | Clinic/Center |
Location | 332 Leavitt Avenue, Jordan, Montana |
Authorized Official Name and Position | Edward Collins (COMMISSIONER) |
Authorized Official Contact | 4065572500 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 389 Jordan MT 59337-0389 Ph: (406) 557-2500 | 332 Leavitt Avenue Jordan MT 59337-0389 Ph: (406) 557-2500 |
NPI Number | 1427508365 |
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Provider Enumeration Date | 10/04/2016 |
Last Update Date | 12/28/2020 |
Medicare PECOS PAC ID | 8325178551 |
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Medicare Enrollment ID | O20120222000586 |
Identifier | Type | State | Issuer |
---|---|---|---|
1427508365 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | J Randall Rauh |
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Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1649378530 PECOS PAC ID: 9638071913 Enrollment ID: I20040611001279 |
Provider Name | Brenda D Koessl |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1619104536 PECOS PAC ID: 8527113687 Enrollment ID: I20090826000430 |
Provider Name | Robert W Gneiting |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1225105919 PECOS PAC ID: 3678709383 Enrollment ID: I20131127001740 |
Provider Name | Dana Goforth |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1932686581 PECOS PAC ID: 4385997279 Enrollment ID: I20201008003116 |
Provider Name | Sarah Nordlund |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1285251231 PECOS PAC ID: 8921406141 Enrollment ID: I20211001001291 |
Provider Name | Leoa A Sanders |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1093853921 PECOS PAC ID: 6204091911 Enrollment ID: I20220912001762 |
Provider Name | Lesa Whitehead |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1750653382 PECOS PAC ID: 7618130238 Enrollment ID: I20230908002533 |