Provider Demographics
NPI:1174668164
Name:RUBY VALLEY HOSPITAL
Entity Type:Organization
Organization Name:RUBY VALLEY HOSPITAL
Other - Org Name:RUBY VALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:DYBDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-842-5453
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:MT
Mailing Address - Zip Code:59749-0336
Mailing Address - Country:US
Mailing Address - Phone:406-842-5453
Mailing Address - Fax:406-842-5455
Practice Address - Street 1:321 MADISON STREET
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MT
Practice Address - Zip Code:59749-0336
Practice Address - Country:US
Practice Address - Phone:406-842-5453
Practice Address - Fax:406-842-5455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUBY VALLEY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-20
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10088275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4101148Medicaid
MT60642OtherBCBS RVH SWING BED COMPON
MT4101148Medicaid