=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770756439
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF MCCONE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2008
-----------------------------------------------------
Last Update Date | 11/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 605 SULLIVAN AVE
-----------------------------------------------------
City | CIRCLE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59215-0047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-485-2444
-----------------------------------------------------
Fax | 406-485-3603
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 47
-----------------------------------------------------
City | CIRCLE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59215-0047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-485-2444
-----------------------------------------------------
Fax | 406-485-3603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE/DIRECTOR
-----------------------------------------------------
Name | SUE GOOD-BROWN
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 406-485-2444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------