Provider Demographics
NPI:1477574713
Name:LINCOLN COUNTY COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:LINCOLN COUNTY COMMUNITY HEALTH CENTER, INC.
Other - Org Name:NORTHWEST COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMONS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:406-283-6919
Mailing Address - Street 1:320 EAST SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923
Mailing Address - Country:US
Mailing Address - Phone:406-283-6900
Mailing Address - Fax:406-293-6622
Practice Address - Street 1:320 EAST SECOND STREET
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923
Practice Address - Country:US
Practice Address - Phone:406-283-6900
Practice Address - Fax:406-293-6622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0730320Medicaid
MTS94936Medicare UPIN
MT0730320Medicaid
271814Medicare Oscar/Certification
MTQ06438Medicare UPIN