Healthcare Provider Details

I. General information

NPI: 1912655028
Provider Name (Legal Business Name): BIGHORN VALLEY HEALTH CENTER, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2022
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 COLLEGE DR
GLENDIVE MT
59330-1405
US

IV. Provider business mailing address

10 4TH ST W
HARDIN MT
59034-1802
US

V. Phone/Fax

Practice location:
  • Phone: 406-377-9410
  • Fax:
Mailing address:
  • Phone: 406-665-4103
  • Fax:

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: MD
Phone: 406-665-4103