Healthcare Provider Details

I. General information

NPI: 1043396054
Provider Name (Legal Business Name): ELKHORN MOUNTAIN HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 SOUTH MAIN
BOULDER MT
59632
US

IV. Provider business mailing address

214 SOUTH MAIN
BOULDER MT
59632-0028
US

V. Phone/Fax

Practice location:
  • Phone: 406-225-4201
  • Fax: 406-225-9161
Mailing address:
  • Phone: 406-225-4201
  • Fax: 406-225-9161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. LEE S SWANSON
Title or Position: VICE PRESIDENT
Credential:
Phone: 406-225-4201