Healthcare Provider Details

I. General information

NPI: 1740223882
Provider Name (Legal Business Name): MADISON VALLEY HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N MAIN ST
ENNIS MT
59729-9998
US

IV. Provider business mailing address

305 N MAIN ST
ENNIS MT
59729-9998
US

V. Phone/Fax

Practice location:
  • Phone: 406-682-6862
  • Fax: 406-682-4756
Mailing address:
  • Phone: 406-682-6862
  • Fax: 406-682-4756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: ALICIA NICHOLSON
Title or Position: CFO
Credential:
Phone: 406-682-6626