Healthcare Provider Details

I. General information

NPI: 1235294687
Provider Name (Legal Business Name): PARK COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 06/04/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 E CALLENDER ST
LIVINGSTON MT
59047-2746
US

IV. Provider business mailing address

414 E CALLENDER ST
LIVINGSTON MT
59047-2746
US

V. Phone/Fax

Practice location:
  • Phone: 406-222-4140
  • Fax: 406-222-4138
Mailing address:
  • Phone: 406-222-4145
  • Fax: 406-222-4763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License NumberRN013198
License Number StateMT

VIII. Authorized Official

Name: DR. LAUREL DESNICK
Title or Position: HEALTH OFFICER
Credential: MD
Phone: 406-222-4145