Healthcare Provider Details

I. General information

NPI: 1750161162
Provider Name (Legal Business Name): LINCOLN COUNTY COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HEALTH PARK DR
LIBBY MT
59923-2001
US

IV. Provider business mailing address

320 E 2ND ST
LIBBY MT
59923-2010
US

V. Phone/Fax

Practice location:
  • Phone: 406-283-6900
  • Fax:
Mailing address:
  • Phone: 406-283-6919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA CLEMONS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 406-283-6919