Provider Demographics
NPI:1174661953
Name:COMMUNITY HOSPITAL OF ANACONDA
Entity Type:Organization
Organization Name:COMMUNITY HOSPITAL OF ANACONDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:I
Authorized Official - Last Name:HICKEY-BOYNTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-563-8521
Mailing Address - Street 1:401 W PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-1931
Mailing Address - Country:US
Mailing Address - Phone:406-563-8500
Mailing Address - Fax:
Practice Address - Street 1:401 W PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-1931
Practice Address - Country:US
Practice Address - Phone:406-563-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10442367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT271335Medicare ID - Type UnspecifiedPROVIDER NUMBER