Healthcare Provider Details

I. General information

NPI: 1962558338
Provider Name (Legal Business Name): HILL COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 4TH AVE
HAVRE MT
59501-3654
US

IV. Provider business mailing address

302 4TH AVE
HAVRE MT
59501-3654
US

V. Phone/Fax

Practice location:
  • Phone: 406-265-5481
  • Fax: 406-265-6792
Mailing address:
  • Phone: 406-265-5481
  • Fax: 406-265-6792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: CINDY L SORENSON
Title or Position: FISCAL OFFICER
Credential:
Phone: 406-265-5481