Provider Demographics
NPI:1003939190
Name:PIONEER MEDICAL CENTER
Entity Type:Organization
Organization Name:PIONEER MEDICAL CENTER
Other - Org Name:PIONEER MEDICAL CENTER CAH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-932-4603
Mailing Address - Street 1:P.O. BOX 1228
Mailing Address - Street 2:301 WEST 7TH AVENUE, SUITE CAH
Mailing Address - City:BIG TIMBER
Mailing Address - State:MT
Mailing Address - Zip Code:59011-1228
Mailing Address - Country:US
Mailing Address - Phone:406-932-4603
Mailing Address - Fax:406-932-5468
Practice Address - Street 1:301 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:BIG TIMBER
Practice Address - State:MT
Practice Address - Zip Code:59011-7893
Practice Address - Country:US
Practice Address - Phone:406-932-4603
Practice Address - Fax:406-932-5468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
282N00000X
MT10783282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT60172OtherBLUE CROSS BLUE SHIELD
MT15731OtherBLUE CROSS BLUE SHIELD
MT0411749Medicaid
MT271313Medicare Oscar/Certification