Provider Demographics
NPI:1073644902
Name:LIBERTY COUNTY PUBLIC HEALTH
Entity Type:Organization
Organization Name:LIBERTY COUNTY PUBLIC HEALTH
Other - Org Name:LIBERTY COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LIBERTY COUNTY PUBLIC HEALTH MANAGE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KANTOROWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:406-759-8256
Mailing Address - Street 1:P.O. BOX 459
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:MT
Mailing Address - Zip Code:59522
Mailing Address - Country:US
Mailing Address - Phone:406-759-8256
Mailing Address - Fax:406-759-5923
Practice Address - Street 1:618 EAST ADAMS
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:MT
Practice Address - Zip Code:59522-0705
Practice Address - Country:US
Practice Address - Phone:406-759-8256
Practice Address - Fax:406-759-5923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIBERTY COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163W00000X
MT251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0350047OtherPIN
MT1073644902Medicaid