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General NPI Number Information
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NPI Number | 1548070394
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Entity Type | Organization
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Legal Business Name | FORT PECK TRIBES
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 215 15TH AVE
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City | BROCKTON
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State | MT
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Zip | 59213
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Country | US
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Telephone | 406-768-3202
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1027
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City | POPLAR
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State | MT
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Zip | 59255-1027
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Country | US
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Telephone | 406-768-2202
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Fax |
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Authorized Official
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Title or Position | TRIBAL HEALTH SERVICE UNIT DIRECTOR
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Name | DENNIS FOUR BEAR
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Credential |
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Telephone | 406-768-3491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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