MEDICARE: BIGHORN VALLEY HEALTH CENTER, INCORPORATED

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	122300000X	Dentist
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1699446195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIGHORN VALLEY HEALTH CENTER, INCORPORATED

Provider Business Mailing Address
First Line	:	10 4TH ST W
Second Line	:
City	:	HARDIN
State	:	MT
Zip	:	59034-1802
Country	:	US
Telephone Number	:	406-535-6545
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 E 5TH ST
Second Line	:
City	:	SHERIDAN
State	:	WY
Zip	:	82801-3658
Country	:	US
Telephone Number	:	406-665-4103
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. DAVID ANDREW MARK
Credential	:	MD
Telephone Number	:	406-665-4103

Provider Enumeration Date	:	09/23/2021
Last Update Date	:	10/11/2023

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