Provider Demographics
NPI:1073675351
Name:PONDERA COUNTY
Entity Type:Organization
Organization Name:PONDERA COUNTY
Other - Org Name:PONDERA COUNTY HEALTH DEPT.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRUBB
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:406-271-3247
Mailing Address - Street 1:311 S. VIRGINIA STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425
Mailing Address - Country:US
Mailing Address - Phone:406-271-3247
Mailing Address - Fax:406-271-3248
Practice Address - Street 1:311 S. VIRGINIA STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425
Practice Address - Country:US
Practice Address - Phone:406-271-3247
Practice Address - Fax:406-271-3248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3503526Medicaid
MT3503526Medicaid