=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760489272
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRAIRIE COUNTY HOSPITAL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2005
-----------------------------------------------------
Last Update Date | 10/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 312 SOUTH ADAMS AVENUE
-----------------------------------------------------
City | TERRY
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59349-0156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-635-5511
-----------------------------------------------------
Fax | 406-635-5510
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 156
-----------------------------------------------------
City | TERRY
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59349-0156
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-635-5511
-----------------------------------------------------
Fax | 406-635-5510
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER RELATIONS
-----------------------------------------------------
Name | JOHNNA MARIE DELOACH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-635-5863
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 275N00000X
-----------------------------------------------------
Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 10124
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 282NC0060X
-----------------------------------------------------
Taxonomy Name | Critical Access Hospital
-----------------------------------------------------
License Number | 10125
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------