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General NPI Number Information
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NPI Number | 1881031862
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Entity Type | Organization
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Legal Business Name | LAME DEER HEALTH CENTER
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Dates
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Enumeration Date | 05/30/2013
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Last Update Date | 05/30/2013
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Provider Practice Location Address
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Address Line | 100 CHEYENNE AVENUE
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City | LAME DEER
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State | MT
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Zip | 59043-9043
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Country | US
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Telephone | 406-477-4497
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Fax | 406-477-4427
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | LAME DEER
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State | MT
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Zip | 59043-0070
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Country | US
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Telephone | 406-477-4497
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Fax | 406-477-4427
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Authorized Official
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Title or Position | ACCOUNTS RECEIVABLE
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Name | MRS. TINA MARIE CADY
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Credential |
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Telephone | 406-477-4497
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 578030
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | R 0055229
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | NUR-RN-LIC 68698
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License Number State | MT
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