Provider Demographics
NPI:1467518761
Name:COUNTY OF WIBAUX
Entity Type:Organization
Organization Name:COUNTY OF WIBAUX
Other - Org Name:WIBAUX COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:406-796-2485
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:WIBAUX
Mailing Address - State:MT
Mailing Address - Zip Code:59353-0117
Mailing Address - Country:US
Mailing Address - Phone:406-796-2485
Mailing Address - Fax:406-796-7685
Practice Address - Street 1:203 S WIBAUX ST
Practice Address - Street 2:
Practice Address - City:WIBAUX
Practice Address - State:MT
Practice Address - Zip Code:59353
Practice Address - Country:US
Practice Address - Phone:406-796-2485
Practice Address - Fax:406-796-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0351033Medicaid
MT31488OtherBLUECROSS BLUESHIELD
MT000003648Medicare PIN
MT31488OtherBLUECROSS BLUESHIELD
MT000003354Medicare PIN