Provider Demographics
NPI:1407877475
Name:BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC INC
Entity Type:Organization
Organization Name:BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC INC
Other - Org Name:COMMUNITY HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:406-496-6033
Mailing Address - Street 1:1145 S MONTANA ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2857
Mailing Address - Country:US
Mailing Address - Phone:406-496-6026
Mailing Address - Fax:406-723-4076
Practice Address - Street 1:1145 S MONTANA ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2857
Practice Address - Country:US
Practice Address - Phone:406-496-6026
Practice Address - Fax:406-723-4076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHR-LIC-87323336C0003X, 3336C0004X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1407877475Medicaid
2052038OtherPK