Provider Demographics
NPI:1336119338
Name:MEMORIAL HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:BEARTOOTH BILLINGS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-446-2345
Mailing Address - Street 1:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-0590
Mailing Address - Country:US
Mailing Address - Phone:406-446-2345
Mailing Address - Fax:406-446-0084
Practice Address - Street 1:2525 NORTH BROADWAY
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-0590
Practice Address - Country:US
Practice Address - Phone:406-446-2345
Practice Address - Fax:406-446-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-24
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10344282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000060732OtherBC/BS CRITICAL ACCESS HOS
MT0412760Medicaid
MT0000060732OtherBC/BS CRITICAL ACCESS HOS