Provider Demographics
NPI:1497964290
Name:HELENA INDIAN ALLIANCE INC
Entity Type:Organization
Organization Name:HELENA INDIAN ALLIANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-442-9244
Mailing Address - Street 1:501 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-2865
Mailing Address - Country:US
Mailing Address - Phone:406-442-9244
Mailing Address - Fax:406-449-5371
Practice Address - Street 1:501 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-2865
Practice Address - Country:US
Practice Address - Phone:406-442-9244
Practice Address - Fax:406-449-5371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT261QF0400X, 261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000224250Medicaid
MT0730067Medicaid
MTG33152Medicare UPIN
MT271804Medicare Oscar/Certification
MT0000224250Medicaid
MTS25037Medicare UPIN
MTA49367Medicare UPIN
MT0730067Medicaid