Provider Demographics
NPI:1508990698
Name:CHOUTEAU COUNTY DISTRICT HOSPITAL
Entity Type:Organization
Organization Name:CHOUTEAU COUNTY DISTRICT HOSPITAL
Other - Org Name:MISSOURI RIVER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BISEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-622-6169
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:FORT BENTON
Mailing Address - State:MT
Mailing Address - Zip Code:59442-0249
Mailing Address - Country:US
Mailing Address - Phone:406-622-3331
Mailing Address - Fax:406-622-5670
Practice Address - Street 1:1501 ST. CHARLES
Practice Address - Street 2:
Practice Address - City:FORT BENTON
Practice Address - State:MT
Practice Address - Zip Code:59442
Practice Address - Country:US
Practice Address - Phone:406-622-3331
Practice Address - Fax:406-622-5670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11053314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT316550Medicaid
MT=========OtherFACILITY TAX I.D.
MT275062Medicare Oscar/Certification