Healthcare Provider Details

I. General information

NPI: 1831771351
Provider Name (Legal Business Name): BUTTE NATIVE WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2021
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E GALENA ST
BUTTE MT
59701-1703
US

IV. Provider business mailing address

55 E GALENA ST
BUTTE MT
59701-1703
US

V. Phone/Fax

Practice location:
  • Phone: 406-782-0461
  • Fax: 406-782-7435
Mailing address:
  • Phone: 406-782-0461
  • Fax: 406-782-7435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TINA RANDALL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 406-782-0461