Provider Demographics
NPI:1518136308
Name:MADISON VALLEY HOSPITAL, INC.
Entity Type:Organization
Organization Name:MADISON VALLEY HOSPITAL, INC.
Other - Org Name:MADISON VALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROHRBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-682-6615
Mailing Address - Street 1:305 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729-9998
Mailing Address - Country:US
Mailing Address - Phone:406-682-6862
Mailing Address - Fax:406-682-4756
Practice Address - Street 1:305 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729-9998
Practice Address - Country:US
Practice Address - Phone:406-682-6862
Practice Address - Fax:406-682-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0720122Medicaid
MT0720122Medicaid