Healthcare Provider Details

I. General information

NPI: 1659483048
Provider Name (Legal Business Name): FORT PECK TRIBES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 H ST
POPLAR MT
59255-1027
US

IV. Provider business mailing address

PO BOX 1027
POPLAR MT
59255-1027
US

V. Phone/Fax

Practice location:
  • Phone: 406-768-5468
  • Fax: 406-768-5121
Mailing address:
  • Phone: 406-768-5468
  • Fax: 406-768-5121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DENNIS FOUR BEAR
Title or Position: CEO
Credential:
Phone: 406-768-3491