Healthcare Provider Details

I. General information

NPI: 1316158280
Provider Name (Legal Business Name): ROCKY BOY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 03/07/2023
Certification Date: 01/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 UPPER BOX ELDER RD
BOX ELDER MT
59521-9073
US

IV. Provider business mailing address

6850 UPPER BOX ELDER RD
BOX ELDER MT
59521-9073
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-4486
  • Fax: 406-395-4408
Mailing address:
  • Phone: 406-395-1617
  • Fax: 406-395-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TERESA HESTON
Title or Position: APPLICATIONS COORDINATOR
Credential:
Phone: 406-395-4486