Healthcare Provider Details

I. General information

NPI: 1265605398
Provider Name (Legal Business Name): EASTERN MONTANA HEALTH COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

507 NORTH LINCOLN AVE BOX 489
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 TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number17
License Number StateMT

VIII. Authorized Official

Name: LEROY N BIESHEUVEL
Title or Position: PHYSICIAN'S ASSISTANT
Credential: PA/C
Phone: 406-436-2651