Healthcare Provider Details

I. General information

NPI: 1598810186
Provider Name (Legal Business Name): BLACKFOOT VALLEY MEDICAL SERVICES CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 200 WEST
LINCOLN MT
59639
US

IV. Provider business mailing address

PO BOX 602
LINCOLN MT
59639-0602
US

V. Phone/Fax

Practice location:
  • Phone: 406-362-4603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateMT

VIII. Authorized Official

Name: MS. ANN PRYOR
Title or Position: CHAIRPERSON
Credential:
Phone: 406-362-4603