Healthcare Provider Details

I. General information

NPI: 1669501573
Provider Name (Legal Business Name): THREE FORKS PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E NEAL ST
THREE FORKS MT
59752-9300
US

IV. Provider business mailing address

212 E NEAL ST
THREE FORKS MT
59752-9300
US

V. Phone/Fax

Practice location:
  • Phone: 406-522-6011
  • Fax: 406-522-6090
Mailing address:
  • Phone: 406-522-6011
  • Fax: 406-522-6090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateMT

VIII. Authorized Official

Name: MR. STEVEN DWAYNE JOHNSON
Title or Position: ASST.. SUPERINTENDENT OF BUSINESS
Credential:
Phone: 406-522-6042