Healthcare Provider Details

I. General information

NPI: 1972513638
Provider Name (Legal Business Name): NORTHERN CHEYENNE TRIBE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 NORTH CHEYENNE AVE
LAME DEER MT
59043-0067
US

IV. Provider business mailing address

22 NORTH CHEYENNE AVE PO BOX 67
LAME DEER MT
59043-0067
US

V. Phone/Fax

Practice location:
  • Phone: 406-477-6775
  • Fax: 406-477-6083
Mailing address:
  • Phone: 406-477-6775
  • Fax: 406-477-6083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number087
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number087
License Number StateMT

VIII. Authorized Official

Name: MS. RACHEL E LARANCE
Title or Position: 3RD PARTY BILLING CLERK
Credential:
Phone: 406-477-4911