Provider Demographics
NPI:1073658605
Name:PHILLIPS COUNTY HOSPITAL ASSN
Entity Type:Organization
Organization Name:PHILLIPS COUNTY HOSPITAL ASSN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-654-1100
Mailing Address - Street 1:311 SOUTH 8TH AVE EAST
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:MT
Mailing Address - Zip Code:59538
Mailing Address - Country:US
Mailing Address - Phone:406-654-1100
Mailing Address - Fax:406-654-2876
Practice Address - Street 1:311 SOUTH 8TH AVE EAST
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:MT
Practice Address - Zip Code:59538
Practice Address - Country:US
Practice Address - Phone:406-654-1100
Practice Address - Fax:406-654-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10813282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT60282OtherBC BS
MT0414479Medicaid
MT03971OtherBC BS LAB XRAY
MT=========OtherTAX ID
MT0414479Medicaid