Provider Demographics
NPI:1336284264
Name:RUBY VALLEY HOSPITAL
Entity Type:Organization
Organization Name:RUBY VALLEY HOSPITAL
Other - Org Name:TWIN BRIDGES RURAL HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:DYBDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-842-5453
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:TWIN BRIDGES
Mailing Address - State:MT
Mailing Address - Zip Code:59754-0352
Mailing Address - Country:US
Mailing Address - Phone:406-684-5546
Mailing Address - Fax:406-684-5547
Practice Address - Street 1:104 S. MADISON ST.
Practice Address - Street 2:
Practice Address - City:TWIN BRIDGES
Practice Address - State:MT
Practice Address - Zip Code:59754-0352
Practice Address - Country:US
Practice Address - Phone:406-684-5546
Practice Address - Fax:406-684-5547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10088261QR1300X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0054470Medicaid
MT94575OtherBCBS RVH TB RHC-FQHC
MT273409Medicare ID - Type UnspecifiedRVH TWIN BRIDGES RHC-FQHC