Provider Demographics
NPI:1356332266
Name:CHOUTEAU COUNTY DISTRICT HOSPITAL
Entity Type:Organization
Organization Name:CHOUTEAU COUNTY DISTRICT HOSPITAL
Other - Org Name:MISSOURI RIVER MED CTR; BENTON MED CTR; GERALDINE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOODHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:406-622-6162
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:FORT BENTON
Mailing Address - State:MT
Mailing Address - Zip Code:59442-0249
Mailing Address - Country:US
Mailing Address - Phone:406-622-3331
Mailing Address - Fax:406-622-5670
Practice Address - Street 1:1501 SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:FORT BENTON
Practice Address - State:MT
Practice Address - Zip Code:59442-7710
Practice Address - Country:US
Practice Address - Phone:406-622-3331
Practice Address - Fax:406-622-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10238282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT414492Medicaid
MT60272OtherBLUE CROSS BLUE SHIELD
MT271304Medicare Oscar/Certification
MT414492Medicaid