Healthcare Provider Details

I. General information

NPI: 1306911169
Provider Name (Legal Business Name): ST. LUKES COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330-6 TRACT LANE
ST. IGNATIUS MT
59865
US

IV. Provider business mailing address

107 6TH AVE SW
RONAN MT
59864-2634
US

V. Phone/Fax

Practice location:
  • Phone: 406-745-2781
  • Fax: 406-745-3080
Mailing address:
  • Phone: 406-676-4441
  • Fax: 406-676-0835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. LIANE CLAIRMONT
Title or Position: EXUECUTIVE ASSISTANT
Credential:
Phone: 406-676-4441