Healthcare Provider Details

I. General information

NPI: 1902161995
Provider Name (Legal Business Name): MINERAL REGIONAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TWO RIVERS PLACE
ST. REGIS MT
59866
US

IV. Provider business mailing address

PO BOX 698
SUPERIOR MT
59872-0698
US

V. Phone/Fax

Practice location:
  • Phone: 406-822-4278
  • Fax:
Mailing address:
  • Phone: 406-822-4278
  • Fax: 406-822-4912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN D. CARTY
Title or Position: DIRECTOR
Credential:
Phone: 406-822-4278