Healthcare Provider Details

I. General information

NPI: 1407024904
Provider Name (Legal Business Name): CACADE CITY-COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 4TH ST S
GREAT FALLS MT
59401-3618
US

IV. Provider business mailing address

115 4TH ST S
GREAT FALLS MT
59401-3618
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-6950
  • Fax: 406-454-6959
Mailing address:
  • Phone: 406-454-6950
  • Fax: 406-454-6959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateMT

VIII. Authorized Official

Name: RICHARD C CORNWELL
Title or Position: ADMIN. SERVICES MGR.
Credential: CPA
Phone: 406-454-6950