=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881811693
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF BLAINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2007
-----------------------------------------------------
Last Update Date | 06/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 420A OHIO
-----------------------------------------------------
City | CHINOOK
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59523-0516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-357-2345
-----------------------------------------------------
Fax | 406-357-3891
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 516 420A OHIO
-----------------------------------------------------
City | CHINOOK
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59523-0516
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-357-2345
-----------------------------------------------------
Fax | 406-357-3891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING AND PROGRAM ASST
-----------------------------------------------------
Name | MARK SCOTT WEBER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-357-2345
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | RN 21995
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP0905X
-----------------------------------------------------
Taxonomy Name | State or Local Public Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------