Provider Demographics
NPI:1275411548
Name:STATE OF MONTANA
Entity type:Organization
Organization Name:STATE OF MONTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO -PROGRAMS & REHAB
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:EYCHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-444-9666
Mailing Address - Street 1:PO BOX 201301
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59620-1301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 CONLEY LAKE RD
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-8708
Practice Address - Country:US
Practice Address - Phone:406-444-3930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF MONTANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center