Healthcare Provider Details

I. General information

NPI: 1487741005
Provider Name (Legal Business Name): BIGHORN VALLEY HEALTH CENTER, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 W LEWIS ST
LIVINGSTON MT
59047-3011
US

IV. Provider business mailing address

112 W LEWIS ST
LIVINGSTON MT
59047-3011
US

V. Phone/Fax

Practice location:
  • Phone: 406-823-6304
  • Fax: 406-222-5798
Mailing address:
  • Phone: 406-823-6314
  • Fax: 406-222-5798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: DAVID ANDREW MARK
Title or Position: CEO
Credential:
Phone: 406-665-4103