Healthcare Provider Details

I. General information

NPI: 1942241401
Provider Name (Legal Business Name): ST. VINCENT HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ROBINSON LN
RED LODGE MT
59068-9010
US

IV. Provider business mailing address

10 ROBINSON LN
RED LODGE MT
59068-9010
US

V. Phone/Fax

Practice location:
  • Phone: 406-446-3800
  • Fax: 406-446-3802
Mailing address:
  • Phone: 406-446-3800
  • Fax: 406-446-3802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number9717
License Number StateMT

VIII. Authorized Official

Name: JASON L. BARKER
Title or Position: PRESIDENT/COO
Credential:
Phone: 406-237-3070