Provider Demographics
NPI:1386194785
Name:COUNTY OF RAVALLI
Entity Type:Organization
Organization Name:COUNTY OF RAVALLI
Other - Org Name:RAVALLI COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SPOONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-375-6675
Mailing Address - Street 1:205 BEDFORD ST
Mailing Address - Street 2:STE L
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2853
Mailing Address - Country:US
Mailing Address - Phone:406-375-6671
Mailing Address - Fax:406-375-6680
Practice Address - Street 1:205 BEDFORD ST
Practice Address - Street 2:STE L
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2853
Practice Address - Country:US
Practice Address - Phone:406-375-6671
Practice Address - Fax:406-375-6680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-10
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT96670251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1225045370Medicaid