Healthcare Provider Details

I. General information

NPI: 1023912052
Provider Name (Legal Business Name): BIGHORN VALLEY HEALTH CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S MEDICAL ARTS CT STE D
GILLETTE WY
82716-3372
US

IV. Provider business mailing address

207 W MAIN ST STE 5
LEWISTOWN MT
59457-2718
US

V. Phone/Fax

Practice location:
  • Phone: 406-665-4103
  • Fax:
Mailing address:
  • Phone: 406-535-6545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID ANDREW MARK
Title or Position: CEO
Credential: MD
Phone: 406-665-4103