Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 305 N Main St, Ennis, Montana |
Authorized Official Name and Position | Allen Rohrback (CEO) |
Authorized Official Contact | 4066826615 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
305 N Main St Ennis MT 59729-9998 Ph: (406) 682-6862 | 305 N Main St Ennis MT 59729-9998 Ph: (406) 682-6862 |
NPI Number | 1518136308 |
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Provider Enumeration Date | 02/26/2008 |
Last Update Date | 09/21/2021 |
Medicare PECOS PAC ID | 7719890987 |
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Medicare Enrollment ID | O20060314000789 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518136308 | NPI | - | NPPES |
0720122 | Medicaid | MT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |