Healthcare Provider Details

I. General information

NPI: 1164894010
Provider Name (Legal Business Name): LINCOLN COUNTY COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E 2ND ST
LIBBY MT
59923-2010
US

IV. Provider business mailing address

320 E 2ND ST
LIBBY MT
59923-2010
US

V. Phone/Fax

Practice location:
  • Phone: 406-283-6979
  • Fax: 406-293-7233
Mailing address:
  • Phone: 406-283-6979
  • Fax: 406-293-7233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHA-PHR-LIC-33478
License Number StateMT

VIII. Authorized Official

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