Provider Demographics
NPI:1497759955
Name:YELLOWSTONE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:YELLOWSTONE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-237-5905
Mailing Address - Street 1:PO BOX 31715
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-1715
Mailing Address - Country:US
Mailing Address - Phone:406-237-5900
Mailing Address - Fax:406-237-5910
Practice Address - Street 1:1144 N 28TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0110
Practice Address - Country:US
Practice Address - Phone:406-237-5900
Practice Address - Fax:406-237-5910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9728261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0351305Medicaid
MT1180258 00Medicaid
MT0351305Medicaid