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General NPI Number Information
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NPI Number | 1851791750
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Entity Type | Organization
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Legal Business Name | POWDER RIVER COUNTY
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Dates
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Enumeration Date | 08/27/2014
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 507 NORTH LINCOLN AVE
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City | BROADUS
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State | MT
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Zip | 59317-0489
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Country | US
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Telephone | 406-436-2651
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Fax | 406-436-2652
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Provider Business Mailing Address
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Address Line | PO BOX 489 507 NORTH LINCOLN AVE
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City | BROADUS
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State | MT
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Zip | 59317-0489
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Country | US
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Telephone | 406-436-2651
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Fax | 406-436-2652
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Authorized Official
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Title or Position | BUSINESS ADMIN
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Name | VIKKI J KLEMM
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Credential |
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Telephone | 406-436-2651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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