Provider Demographics
NPI:1497865026
Name:CULBERTSON FROID BAINVILLE HEALTH CARE CORPORATION
Entity Type:Organization
Organization Name:CULBERTSON FROID BAINVILLE HEALTH CARE CORPORATION
Other - Org Name:ROOSEVELT MEMORIAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:STROMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-787-6401
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:CULBERTSON
Mailing Address - State:MT
Mailing Address - Zip Code:59218-0419
Mailing Address - Country:US
Mailing Address - Phone:406-787-6401
Mailing Address - Fax:406-787-6461
Practice Address - Street 1:818 2ND AVE E
Practice Address - Street 2:
Practice Address - City:CULBERTSON
Practice Address - State:MT
Practice Address - Zip Code:59218-9363
Practice Address - Country:US
Practice Address - Phone:406-787-6401
Practice Address - Fax:406-787-6289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10739275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT310-0358Medicaid
MT310-0358Medicaid