Provider Demographics
NPI:1003466822
Name:BATES FAMILY DIVERSIFIED, LLC
Entity Type:Organization
Organization Name:BATES FAMILY DIVERSIFIED, LLC
Other - Org Name:THREE RIVERS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:406-285-3251
Mailing Address - Street 1:16 RAILWAY AVE
Mailing Address - Street 2:
Mailing Address - City:THREE FORKS
Mailing Address - State:MT
Mailing Address - Zip Code:59752-9080
Mailing Address - Country:US
Mailing Address - Phone:406-285-3251
Mailing Address - Fax:406-285-6742
Practice Address - Street 1:16 RAILWAY AVE
Practice Address - Street 2:
Practice Address - City:THREE FORKS
Practice Address - State:MT
Practice Address - Zip Code:59752-9080
Practice Address - Country:US
Practice Address - Phone:406-285-3251
Practice Address - Fax:406-285-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty