Provider Demographics
NPI:1043266356
Name:FRANCES MAHON DEACONESS HOSPITAL
Entity Type:Organization
Organization Name:FRANCES MAHON DEACONESS HOSPITAL
Other - Org Name:GLASGOW CLINIC INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHYSICIAN RECRUITMENT
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNELLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-228-3609
Mailing Address - Street 1:221 5TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-2600
Mailing Address - Country:US
Mailing Address - Phone:406-228-3400
Mailing Address - Fax:
Practice Address - Street 1:221 5TH AVE S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2600
Practice Address - Country:US
Practice Address - Phone:406-228-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCES MAHON DEACONESS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10542261Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0720486Medicaid
MTDC8692OtherMEDICARE RAILROAD
MTDC8692OtherMEDICARE RAILROAD