Healthcare Provider Details

I. General information

NPI: 1285203257
Provider Name (Legal Business Name): ST. JOHN'S LUTHERAN HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 HEALTH PARK DR
LIBBY MT
59923-2001
US

IV. Provider business mailing address

209 HEALTH PARK DR
LIBBY MT
59923-2001
US

V. Phone/Fax

Practice location:
  • Phone: 406-283-7189
  • Fax: 406-293-2453
Mailing address:
  • Phone: 406-283-7189
  • Fax: 406-293-2453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JULIE L LEONARD
Title or Position: CFO
Credential:
Phone: 406-283-7219