Provider Demographics
NPI:1073687406
Name:WHEATLAND MEMORIAL HEALTHCARE
Entity Type:Organization
Organization Name:WHEATLAND MEMORIAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-632-3115
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:HARLOWTON
Mailing Address - State:MT
Mailing Address - Zip Code:59036-0287
Mailing Address - Country:US
Mailing Address - Phone:406-632-4351
Mailing Address - Fax:406-632-3172
Practice Address - Street 1:530 3RD ST NW
Practice Address - Street 2:
Practice Address - City:HARLOWTON
Practice Address - State:MT
Practice Address - Zip Code:59036
Practice Address - Country:US
Practice Address - Phone:406-632-4351
Practice Address - Fax:406-632-3174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-18
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT107879282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0412488Medicaid
MT0720278Medicaid
MT3100565Medicaid
MT0412488Medicaid
MT0720278Medicaid
MT273986Medicare PIN