Provider Demographics
NPI:1326149261
Name:YELLOWSTONE FAMILY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:YELLOWSTONE FAMILY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:L
Authorized Official - Middle Name:ELANE
Authorized Official - Last Name:SHIRAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-646-0200
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:236 YELLOWSTONE AVENUE
Mailing Address - City:WEST YELLOWSTONE
Mailing Address - State:MT
Mailing Address - Zip Code:59758-0427
Mailing Address - Country:US
Mailing Address - Phone:406-646-0200
Mailing Address - Fax:406-646-0400
Practice Address - Street 1:236 YELLOWSTONE AVENUE
Practice Address - Street 2:
Practice Address - City:WEST YELLOWSTONE
Practice Address - State:MT
Practice Address - Zip Code:59758-0427
Practice Address - Country:US
Practice Address - Phone:406-646-0200
Practice Address - Fax:406-646-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10013207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT9989343Medicaid
MT9989343Medicaid