Provider Demographics
NPI:1235294687
Name:PARK COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:PARK COUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR NURSING SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:406-222-4140
Mailing Address - Street 1:414 E CALLENDER ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2746
Mailing Address - Country:US
Mailing Address - Phone:406-222-4140
Mailing Address - Fax:406-222-4138
Practice Address - Street 1:414 E CALLENDER ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-2746
Practice Address - Country:US
Practice Address - Phone:406-222-4140
Practice Address - Fax:406-222-4138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN013198163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal NewbornGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT290316Medicaid
MT290602Medicaid
MT3501381Medicaid