Healthcare Provider Details

I. General information

NPI: 1932253093
Provider Name (Legal Business Name): ST JOHN'S LUTHERAN HOSPITAL PHYSICIAN'S SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 LOUISIANA AVE
LIBBY MT
59923-2131
US

IV. Provider business mailing address

401 LOUISIANA AVE
LIBBY MT
59923-2131
US

V. Phone/Fax

Practice location:
  • Phone: 406-293-0100
  • Fax: 406-293-7931
Mailing address:
  • Phone: 406-293-0100
  • Fax: 406-293-7931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC0050X
TaxonomyCritical Access Hospital Clinic/Center
License Number10828
License Number StateMT

VIII. Authorized Official

Name: MRS. ANN BROTHERS
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 406-293-0100