Healthcare Provider Details

I. General information

NPI: 1740344589
Provider Name (Legal Business Name): COUNTY OF BROADWATER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N CEDAR ST
TOWNSEND MT
59644-2300
US

IV. Provider business mailing address

124 N CEDAR ST
TOWNSEND MT
59644-2300
US

V. Phone/Fax

Practice location:
  • Phone: 406-266-5209
  • Fax: 406-266-3940
Mailing address:
  • Phone: 406-266-5209
  • Fax: 406-266-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberD20580
License Number StateMT

VIII. Authorized Official

Name: DIANE THORNE
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 406-266-5209