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General NPI Number Information
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NPI Number | 1932253093
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Entity Type | Organization
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Legal Business Name | ST JOHN'S LUTHERAN HOSPITAL PHYSICIAN'S SERVICES
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 401 LOUISIANA AVE
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City | LIBBY
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State | MT
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Zip | 59923-2131
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Country | US
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Telephone | 406-293-0100
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Fax | 406-293-7931
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Provider Business Mailing Address
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Address Line | 401 LOUISIANA AVE
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City | LIBBY
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State | MT
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Zip | 59923-2131
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Country | US
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Telephone | 406-293-0100
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Fax | 406-293-7931
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | MRS. ANN BROTHERS
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Credential |
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Telephone | 406-293-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC0050X
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Taxonomy Name | Critical Access Hospital Clinic/Center
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License Number | 10828
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License Number State | MT
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