Provider Demographics
NPI:1164894010
Name:LINCOLN COUNTY COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:LINCOLN COUNTY COMMUNITY HEALTH CENTER INC
Other - Org Name:NORTHWEST COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-283-6919
Mailing Address - Street 1:320 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2010
Mailing Address - Country:US
Mailing Address - Phone:406-283-6979
Mailing Address - Fax:406-293-7233
Practice Address - Street 1:320 E 2ND ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2010
Practice Address - Country:US
Practice Address - Phone:406-283-6979
Practice Address - Fax:406-293-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MTPHA-PHR-LIC-334783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154975OtherPK