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General NPI Number Information
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NPI Number | 1275560617
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Entity Type | Organization
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Legal Business Name | POWELL COUNTY MEMORIAL HOSPITAL ASSOCIATION INC
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Dates
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Enumeration Date | 06/28/2006
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Last Update Date | 04/03/2024
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Provider Practice Location Address
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Address Line | 1100 HOLLENBACK LANE
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City | DEER LODGE
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State | MT
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Zip | 59722-1828
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Country | US
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Telephone | 406-846-2212
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Fax | 406-846-3074
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Provider Business Mailing Address
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Address Line | 1100 HOLLENBACK LANE
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City | DEER LODGE
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State | MT
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Zip | 59722-1828
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Country | US
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Telephone | 406-846-2212
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Fax | 406-846-3074
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Authorized Official
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Title or Position | COO
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Name | JAENA RICHARDS
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Credential |
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Telephone | 406-846-7717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 9623
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 10408
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License Number State | MT
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