Healthcare Provider Details

I. General information

NPI: 1851791750
Provider Name (Legal Business Name): POWDER RIVER COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2014
Last Update Date: 02/06/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 NORTH LINCOLN AVE
BROADUS MT
59317-0489
US

IV. Provider business mailing address

PO BOX 489 507 NORTH LINCOLN AVE
BROADUS MT
59317-0489
US

V. Phone/Fax

Practice location:
  • Phone: 406-436-2651
  • Fax: 406-436-2652
Mailing address:
  • Phone: 406-436-2651
  • Fax: 406-436-2652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIKKI J KLEMM
Title or Position: BUSINESS ADMIN
Credential:
Phone: 406-436-2651