Healthcare Provider Details

I. General information

NPI: 1902962103
Provider Name (Legal Business Name): ANACONDA DEER LODGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E 7TH ST STE 1E
ANACONDA MT
59711-2953
US

IV. Provider business mailing address

P.O. BOX 970
ANACONDA MT
59711-0970
US

V. Phone/Fax

Practice location:
  • Phone: 406-563-7863
  • Fax: 406-563-2387
Mailing address:
  • Phone: 406-563-7863
  • Fax: 406-563-2387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: LAUREN BOLTON
Title or Position: HEALTH OFFICER
Credential:
Phone: 406-563-7863