Provider Demographics
NPI:1073877742
Name:MINERAL REGIONAL HEALTH CENTER INC.
Entity Type:Organization
Organization Name:MINERAL REGIONAL HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-822-4841
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:MT
Mailing Address - Zip Code:59872-0698
Mailing Address - Country:US
Mailing Address - Phone:406-822-4278
Mailing Address - Fax:
Practice Address - Street 1:1208 6TH AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:MT
Practice Address - Zip Code:59872-9618
Practice Address - Country:US
Practice Address - Phone:406-822-4278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011002765OtherMEDICARE PTAN
MTM011002765OtherMEDICARE PTAN