Healthcare Provider Details

I. General information

NPI: 1669508768
Provider Name (Legal Business Name): LAME DEER HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHEYENNE AVE
LAME DEER MT
59043
US

IV. Provider business mailing address

100 CHEYENNE AVE PO BOX 70
LAME DEER MT
59043
US

V. Phone/Fax

Practice location:
  • Phone: 406-477-4448
  • Fax: 406-477-4427
Mailing address:
  • Phone: 406-477-4448
  • Fax: 406-477-4427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA LARSEN
Title or Position: AREA BUSINESS OFFICE COORDINATOR
Credential:
Phone: 406-247-7184