Healthcare Provider Details

I. General information

NPI: 1104909696
Provider Name (Legal Business Name): BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 MADISON ST
SHERIDAN MT
59749-9636
US

IV. Provider business mailing address

PO BOX 525
SHERIDAN MT
59749-0525
US

V. Phone/Fax

Practice location:
  • Phone: 406-842-7434
  • Fax: 406-842-5733
Mailing address:
  • Phone: 406-842-7434
  • Fax: 406-842-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPHA-PHR-LIC-1315
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHA-PHR-LIC-1315
License Number StateMT

VIII. Authorized Official

Name: SHAWNA MARIE YATES
Title or Position: EXECUTIVE DIRECTOR
Credential: DO
Phone: 406-496-6018