Provider Demographics
NPI:1497151971
Name:BULLHOOK COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:BULLHOOK COMMUNITY HEALTH CENTER, INC.
Other - Org Name:BULLHOOK COMMUNITY HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PATIENT ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROZAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEDERRICH KERR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-395-6919
Mailing Address - Street 1:521 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-3649
Mailing Address - Country:US
Mailing Address - Phone:406-395-6906
Mailing Address - Fax:406-395-5643
Practice Address - Street 1:521 4TH ST
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-3649
Practice Address - Country:US
Practice Address - Phone:406-395-6906
Practice Address - Fax:406-395-5643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X, 332B00000X, 333600000X
MT272013336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No251S00000XAgenciesCommunity/Behavioral Health
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7169968Medicaid
2148682OtherPK