Healthcare Provider Details

I. General information

NPI: 1801234141
Provider Name (Legal Business Name): POWDER RIVER COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 NORTH TRAUTMAN
BROADUS MT
59317
US

IV. Provider business mailing address

PO BOX 200
BROADUS MT
59317-0200
US

V. Phone/Fax

Practice location:
  • Phone: 406-436-2646
  • Fax:
Mailing address:
  • Phone: 406-436-2657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN D AMENDE
Title or Position: CLERK AND RECORDER
Credential:
Phone: 406-436-2657