Provider Demographics
NPI:1407989593
Name:CHOUTEAU COUNTY DISTRICT HOSPITAL
Entity Type:Organization
Organization Name:CHOUTEAU COUNTY DISTRICT HOSPITAL
Other - Org Name:BENTON MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-622-3331
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:406-622-5485
Mailing Address - Fax:406-622-6217
Practice Address - Street 1:1518 CHOUTEAU ST
Practice Address - Street 2:
Practice Address - City:FORT BENTON
Practice Address - State:MT
Practice Address - Zip Code:59442-9003
Practice Address - Country:US
Practice Address - Phone:406-622-5485
Practice Address - Fax:406-622-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT720174Medicaid
MT720174Medicaid