MEDICARE: BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC INC

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	261QC1500X	Community Health Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1225502073
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC INC

Provider Business Mailing Address
First Line	:	445 CENTENNIAL AVE
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-2870
Country	:	US
Telephone Number	:	406-723-4075
Fax Number	:	406-496-6035

Provider Business Practice Location Address
First Line	:	110 OAK ST
Second Line	:
City	:	ANACONDA
State	:	MT
Zip	:	59711-2335
Country	:	US
Telephone Number	:	406-563-0771
Fax Number	:	406-563-0774

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	KAYLA M MEDINA
Credential	:
Telephone Number	:	460-496-6045

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	02/12/2026

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