Healthcare Provider Details

I. General information

NPI: 1790771699
Provider Name (Legal Business Name): SIDNEY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 14TH AVE SW
SIDNEY MT
59270-3519
US

IV. Provider business mailing address

216 14TH AVE SW
SIDNEY MT
59270-3519
US

V. Phone/Fax

Practice location:
  • Phone: 406-488-2163
  • Fax: 406-488-2238
Mailing address:
  • Phone: 406-488-2163
  • Fax: 406-488-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License NumberPHA-PHI-LIC-1013
License Number StateMT

VIII. Authorized Official

Name: LYNNE BEYERLE
Title or Position: DIRECTOR OF PHARMACY
Credential: PHARMD RPH
Phone: 406-488-2131