MEDICARE: COUNTY OF JEFFERSON

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	251300000X	Local Education Agency (LEA)

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

General Provider Information

NPI Number	:	1558489344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF JEFFERSON

Provider Business Mailing Address
First Line	:	PO BOX 1280
Second Line	:
City	:	EAST HELENA
State	:	MT
Zip	:	59635-1280
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 MCCLELLAN CREEK RD
Second Line	:
City	:	MONTANA CITY
State	:	MT
Zip	:	59634-9620
Country	:	US
Telephone Number	:	406-442-6779
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	VAUGHN KAUFFMAN
Credential	:
Telephone Number	:	406-227-7322

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	06/24/2008

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