Healthcare Provider Details

I. General information

NPI: 1497759955
Provider Name (Legal Business Name): YELLOWSTONE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 N 28TH ST
BILLINGS MT
59101-0110
US

IV. Provider business mailing address

PO BOX 31715
BILLINGS MT
59107-1715
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-5900
  • Fax: 406-237-5910
Mailing address:
  • Phone: 406-237-5900
  • Fax: 406-237-5910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number9728
License Number StateMT

VIII. Authorized Official

Name: MR. ROBERT GAGNON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 406-237-5905