Healthcare Provider Details

I. General information

NPI: 1578732707
Provider Name (Legal Business Name): VA MONTANA HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S WINCHESTER AVE
MILES CITY MT
59301-4757
US

IV. Provider business mailing address

210 S WINCHESTER AVE
MILES CITY MT
59301-4757
US

V. Phone/Fax

Practice location:
  • Phone: 406-874-5666
  • Fax:
Mailing address:
  • Phone: 406-874-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number697
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number135081
License Number StateMT

VIII. Authorized Official

Name: MS. KAREN FOULGER
Title or Position: MEDICAL TECHNOLOGIST
Credential: MT,ASCP,NCA
Phone: 406-874-5666