Healthcare Provider Details

I. General information

NPI: 1902942469
Provider Name (Legal Business Name): GRANITE CNTY MED HOSP PHCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SANSOME ST
PHILIPSBURG MT
59858-0729
US

IV. Provider business mailing address

PO BOX 729
PHILIPSBURG MT
59858-0729
US

V. Phone/Fax

Practice location:
  • Phone: 406-859-3271
  • Fax: 406-859-3011
Mailing address:
  • Phone: 406-859-3271
  • Fax: 406-859-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number252
License Number StateMT

VIII. Authorized Official

Name: AMY WEBB
Title or Position: ADMNSTR
Credential: NHA
Phone: 406-859-3271