Healthcare Provider Details

I. General information

NPI: 1609463934
Provider Name (Legal Business Name): BIGHORN VALLEY HEALTH CENTER, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 W BELL ST STE 15
GLENDIVE MT
59330-3240
US

IV. Provider business mailing address

10 4TH ST W
HARDIN MT
59034-1802
US

V. Phone/Fax

Practice location:
  • Phone: 406-851-5831
  • Fax: 833-314-0429
Mailing address:
  • Phone: 406-851-5831
  • Fax: 833-314-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID ANDREW MARK
Title or Position: CEO
Credential:
Phone: 406-665-4103