Provider Demographics
NPI:1093148207
Name:INDIAN HEALTH SERVICES
Entity Type:Organization
Organization Name:INDIAN HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NURSE
Authorized Official - Prefix:MISS
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BLACKWEASEL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:406-470-0754
Mailing Address - Street 1:760 HOPSPITAL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-0730
Mailing Address - Country:US
Mailing Address - Phone:406-338-6230
Mailing Address - Fax:
Practice Address - Street 1:760 HOSPITAL CIRCLE
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417-0730
Practice Address - Country:US
Practice Address - Phone:406-338-6230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-12
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT46418282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1861409955Medicare UPIN