Provider Demographics
NPI:1477734416
Name:POWELL COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:POWELL COUNTY HEALTH DEPARTMENT
Other - Org Name:POWELL COUNTY PUBLIC HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:406-846-2420
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722-0716
Mailing Address - Country:US
Mailing Address - Phone:406-846-2420
Mailing Address - Fax:406-846-3436
Practice Address - Street 1:304 MILWAUKEE AVE STE 23
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722-1035
Practice Address - Country:US
Practice Address - Phone:406-846-2420
Practice Address - Fax:406-846-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0350051Medicaid