Healthcare Provider Details

I. General information

NPI: 1912203605
Provider Name (Legal Business Name): VA MONTANA HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 05/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 VETERANS DR
FORT HARRISON MT
59636-9703
US

IV. Provider business mailing address

3687 VETERANS DR
FORT HARRISON MT
59636-9703
US

V. Phone/Fax

Practice location:
  • Phone: 406-442-6410
  • Fax:
Mailing address:
  • Phone: 406-442-6410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number10939
License Number StateMT

VIII. Authorized Official

Name: DR. KURT WERNER
Title or Position: ACTING CHIEF OF STAFF
Credential: M.D.
Phone: 406-442-6410