Healthcare Provider Details

I. General information

NPI: 1881811693
Provider Name (Legal Business Name): COUNTY OF BLAINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420A OHIO
CHINOOK MT
59523-0516
US

IV. Provider business mailing address

P.O. BOX 516 420A OHIO
CHINOOK MT
59523-0516
US

V. Phone/Fax

Practice location:
  • Phone: 406-357-2345
  • Fax: 406-357-3891
Mailing address:
  • Phone: 406-357-2345
  • Fax: 406-357-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberRN 21995
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK SCOTT WEBER
Title or Position: BILLING AND PROGRAM ASST
Credential:
Phone: 406-357-2345