Healthcare Provider Details

I. General information

NPI: 1174537179
Provider Name (Legal Business Name): SIDNEY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 SOUTH ELLERY AVE.
FAIRVIEW MT
59221
US

IV. Provider business mailing address

304 SOUTH ELLERY AVE.
FAIRVIEW MT
59221
US

V. Phone/Fax

Practice location:
  • Phone: 406-742-5222
  • Fax: 406-742-5263
Mailing address:
  • Phone: 406-742-5222
  • Fax: 406-742-5263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number813
License Number StateMT

VIII. Authorized Official

Name: DR. LYNN WAYNE BEYERLE
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARM.D.
Phone: 406-742-5222