Healthcare Provider Details

I. General information

NPI: 1649192527
Provider Name (Legal Business Name): MRS. ELENA SOUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 H ST
POPLAR MT
59255-9519
US

IV. Provider business mailing address

PO BOX 245
SCOBEY MT
59263-0245
US

V. Phone/Fax

Practice location:
  • Phone: 406-768-6100
  • Fax:
Mailing address:
  • Phone: 406-783-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNUR-RN-LIC-128761
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: