Provider Demographics
NPI:1376606517
Name:POWDER RIVER PUBLICHEALTH
Entity Type:Organization
Organization Name:POWDER RIVER PUBLICHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACI
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:406-436-2297
Mailing Address - Street 1:PO BOX 210
Mailing Address - Street 2:507 N. LINCOLN
Mailing Address - City:BROADUS
Mailing Address - State:MT
Mailing Address - Zip Code:59317-0210
Mailing Address - Country:US
Mailing Address - Phone:406-436-2297
Mailing Address - Fax:406-436-2315
Practice Address - Street 1:507 N. LINCOLN
Practice Address - Street 2:
Practice Address - City:BROADUS
Practice Address - State:MT
Practice Address - Zip Code:59317-0210
Practice Address - Country:US
Practice Address - Phone:406-436-2297
Practice Address - Fax:406-436-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN24922163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty