Healthcare Provider Details

I. General information

NPI: 1700859923
Provider Name (Legal Business Name): NORTHERN MONTANA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 13TH ST
HAVRE MT
59501-5222
US

IV. Provider business mailing address

PO BOX 1231
HAVRE MT
59501-1231
US

V. Phone/Fax

Practice location:
  • Phone: 406-262-1302
  • Fax: 406-265-1651
Mailing address:
  • Phone: 406-262-1302
  • Fax: 406-265-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number11041
License Number StateMT

VIII. Authorized Official

Name: DR. KEVIN A. HARADA
Title or Position: PRESIDENT/CEO
Credential: M.D.
Phone: 406-262-1302