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General NPI Number Information
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NPI Number | 1952402208
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Entity Type | Organization
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Legal Business Name | CONFEDERATED SALISH AND KOOTENAI TRIBES OF THE FLATHEAD RESERVATION
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 01/08/2024
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Provider Practice Location Address
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Address Line | 35401 MISSION DRIVE
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City | SAINT IGNATIUS
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State | MT
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Zip | 59865-9676
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Country | US
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Telephone | 406-745-3525
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Fax | 406-745-4721
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Provider Business Mailing Address
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Address Line | PO BOX 278
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City | PABLO
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State | MT
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Zip | 59855-0278
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Country | US
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Telephone | 406-675-2700
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Fax | 406-275-2806
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Authorized Official
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Title or Position | CHAIRMAN
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Name | MR. JOSEPH DURGLO
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Credential |
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Telephone | 406-675-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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