Healthcare Provider Details

I. General information

NPI: 1326138579
Provider Name (Legal Business Name): PONDERA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 1ST ST NE
CHOTEAU MT
59422
US

IV. Provider business mailing address

PO BOX 758
CONRAD MT
59425-0758
US

V. Phone/Fax

Practice location:
  • Phone: 406-271-3211
  • Fax: 406-271-3917
Mailing address:
  • Phone: 406-271-3211
  • Fax: 406-271-7661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK JONES
Title or Position: C.O.O.
Credential:
Phone: 406-271-3211