Healthcare Provider Details

I. General information

NPI: 1275560617
Provider Name (Legal Business Name): POWELL COUNTY MEMORIAL HOSPITAL ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 HOLLENBACK LANE
DEER LODGE MT
59722-1828
US

IV. Provider business mailing address

1100 HOLLENBACK LANE
DEER LODGE MT
59722-1828
US

V. Phone/Fax

Practice location:
  • Phone: 406-846-2212
  • Fax: 406-846-3074
Mailing address:
  • Phone: 406-846-2212
  • Fax: 406-846-3074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number9623
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number10408
License Number StateMT

VIII. Authorized Official

Name: JAENA RICHARDS
Title or Position: COO
Credential:
Phone: 406-846-7717