MEDICARE: ST. PETER'S HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	9772	MT
2	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1194785154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. PETER'S HEALTH

Provider Business Mailing Address
First Line	:	435 S CRYSTAL ST STE 300
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-1506
Country	:	US
Telephone Number	:	406-723-0023
Fax Number	:	406-723-8123

Provider Business Practice Location Address
First Line	:	435 S CRYSTAL ST
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-1506
Country	:	US
Telephone Number	:	406-723-0023
Fax Number	:	406-723-8123

Authorized Official
Title or Position	:	SR DIRECTOR OF REVENUE CYCLE
Name	:	DEVON RICHARD MURRAY
Credential	:
Telephone Number	:	406-447-2787

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	04/28/2022

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