Healthcare Provider Details

I. General information

NPI: 1760836167
Provider Name (Legal Business Name): YELLOWSTONE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 SPRING CREEK DR
BILLINGS MT
59102-6747
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 Number
License Number State

VIII. Authorized Official

Name: ROBERT GAGNON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 406-237-5900