Healthcare Provider Details

I. General information

NPI: 1326167875
Provider Name (Legal Business Name): TETON MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 4TH ST NW
CHOTEAU MT
59422-9123
US

IV. Provider business mailing address

915 4TH ST NW
CHOTEAU MT
59422-9123
US

V. Phone/Fax

Practice location:
  • Phone: 406-466-5763
  • Fax:
Mailing address:
  • Phone: 406-466-5763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number668
License Number StateMT

VIII. Authorized Official

Name: MR. BRYAN WILLIAM CHALMERS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 406-466-5763