Healthcare Provider Details

I. General information

NPI: 1780764274
Provider Name (Legal Business Name): GLACIER COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 E MAIN ST
CUT BANK MT
59427-3015
US

IV. Provider business mailing address

519 E MAIN ST
CUT BANK MT
59427-3015
US

V. Phone/Fax

Practice location:
  • Phone: 406-873-5670
  • Fax: 406-873-5675
Mailing address:
  • Phone: 406-873-5670
  • Fax: 406-873-5675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA L HAAS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 406-873-5670