Provider Demographics
NPI:1003861899
Name:PEAK MEDICAL MONTANA OPERATIONS, LLC
Entity Type:Organization
Organization Name:PEAK MEDICAL MONTANA OPERATIONS, LLC
Other - Org Name:BUTTE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:2400 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-6563
Mailing Address - Country:US
Mailing Address - Phone:406-723-6556
Mailing Address - Fax:
Practice Address - Street 1:2400 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-6563
Practice Address - Country:US
Practice Address - Phone:406-723-6556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEAK MEDICAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13066314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3400930Medicaid
MT0534514Medicaid
MT310267Medicaid
MT3400935Medicaid
MT275103Medicare Oscar/Certification