Provider Demographics
NPI:1508351040
Name:RIVERWOOD HEALTH MONTANA
Entity Type:Organization
Organization Name:RIVERWOOD HEALTH MONTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:COLLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:406-531-2978
Mailing Address - Street 1:2910 PROSPECT AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-9726
Mailing Address - Country:US
Mailing Address - Phone:406-327-7003
Mailing Address - Fax:
Practice Address - Street 1:2910 PROSPECT AVE STE 2
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-9726
Practice Address - Country:US
Practice Address - Phone:406-327-7003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty