Healthcare Provider Details

I. General information

NPI: 1508351040
Provider Name (Legal Business Name): RIVERWOOD HEALTH MONTANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 PROSPECT AVE STE 2
HELENA MT
59601-9726
US

IV. Provider business mailing address

2910 PROSPECT AVE STE 2
HELENA MT
59601-9726
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-7003
  • Fax:
Mailing address:
  • Phone: 406-327-7003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: PAULA SUZANNE COLLEDGE
Title or Position: OWNER/PROVIDER
Credential: PA-C
Phone: 406-531-2978