Healthcare Provider Details

I. General information

NPI: 1336119338
Provider Name (Legal Business Name): MEMORIAL HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NORTH BROADWAY
RED LODGE MT
59068-0590
US

IV. Provider business mailing address

PO BOX 590
RED LODGE MT
59068-0590
US

V. Phone/Fax

Practice location:
  • Phone: 406-446-2345
  • Fax: 406-446-0084
Mailing address:
  • Phone: 406-446-2345
  • Fax: 406-446-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number10344
License Number StateMT

VIII. Authorized Official

Name: MS. ABBY LOTZ
Title or Position: CEO
Credential:
Phone: 406-446-2345