Provider Demographics
NPI:1326167875
Name:TETON MEDICAL CENTER
Entity Type:Organization
Organization Name:TETON MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CHALMERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-466-5763
Mailing Address - Street 1:915 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CHOTEAU
Mailing Address - State:MT
Mailing Address - Zip Code:59422-9123
Mailing Address - Country:US
Mailing Address - Phone:406-466-5763
Mailing Address - Fax:
Practice Address - Street 1:915 4TH ST NW
Practice Address - Street 2:
Practice Address - City:CHOTEAU
Practice Address - State:MT
Practice Address - Zip Code:59422-9123
Practice Address - Country:US
Practice Address - Phone:406-466-5763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
MT6683336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3100357Medicaid
MT311597Medicaid
MT4108143Medicaid
MT3100357Medicaid
MT271307Medicare Oscar/Certification
MT311597Medicaid