Healthcare Provider Details

I. General information

NPI: 1932265238
Provider Name (Legal Business Name): ST. JOHN'S LUTHERAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 LOUISIANA AVE
LIBBY MT
59923-2130
US

IV. Provider business mailing address

350 LOUISIANA AVE
LIBBY MT
59923-2130
US

V. Phone/Fax

Practice location:
  • Phone: 406-293-0112
  • Fax: 406-293-7931
Mailing address:
  • Phone: 406-293-0112
  • Fax: 406-293-7931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number10828
License Number StateMT

VIII. Authorized Official

Name: MS. ANN MARIE BROTHERS
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 406-293-0112