Provider Demographics
NPI:1326156019
Name:PLAINS HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:PLAINS HOSPITAL CORPORATION
Other - Org Name:BULL RIVER FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:E
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-826-4814
Mailing Address - Street 1:10 KRUGER RD
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-9506
Mailing Address - Country:US
Mailing Address - Phone:406-826-4816
Mailing Address - Fax:406-826-4898
Practice Address - Street 1:1029 HWY 200
Practice Address - Street 2:
Practice Address - City:NOXON
Practice Address - State:MT
Practice Address - Zip Code:59853
Practice Address - Country:US
Practice Address - Phone:406-826-4816
Practice Address - Fax:406-826-4898
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PLAINS HOSPITAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10608261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT66512OtherBLUE CROSS/MONTANA
MT0722077Medicaid
MT66512OtherBLUE CROSS/MONTANA
MT000080331Medicare PIN