MEDICARE: BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PHA-PHR-LIC-8732	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2052038	OTHER		PK

General Provider Information

NPI Number	:	1407877475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC INC

Provider Business Mailing Address
First Line	:	1145 S MONTANA ST
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-2857
Country	:	US
Telephone Number	:	406-496-6026
Fax Number	:	406-723-4076

Provider Business Practice Location Address
First Line	:	1145 S MONTANA ST
Second Line	:
City	:	BUTTE
State	:	MT
Zip	:	59701-2857
Country	:	US
Telephone Number	:	406-496-6026
Fax Number	:	406-723-4076

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	KAYLA M MEDINA
Credential	:
Telephone Number	:	406-496-6045

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	02/12/2026

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