Healthcare Provider Details

I. General information

NPI: 1093809196
Provider Name (Legal Business Name): MISSOULA COMMUNITY HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 04/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 6TH AVE
SUPERIOR MT
59872-9618
US

IV. Provider business mailing address

PO BOX 66
SUPERIOR MT
59872-0066
US

V. Phone/Fax

Practice location:
  • Phone: 406-822-4841
  • Fax: 406-822-4963
Mailing address:
  • Phone: 406-822-4841
  • Fax: 406-822-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number10034
License Number StateMT

VIII. Authorized Official

Name: MR. JOHN S MCNEECE
Title or Position: CEO
Credential:
Phone: 406-822-4841