Provider Demographics
NPI:1528023520
Name:ST. PETER'S HEALTH
Entity Type:Organization
Organization Name:ST. PETER'S HEALTH
Other - Org Name:ST. PETER'S HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:406-444-2101
Mailing Address - Street 1:2475 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4928
Mailing Address - Country:US
Mailing Address - Phone:406-444-2100
Mailing Address - Fax:406-444-2389
Practice Address - Street 1:2475 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4928
Practice Address - Country:US
Practice Address - Phone:406-444-2100
Practice Address - Fax:406-444-2389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9766282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT417677Medicaid
MT0000000372OtherBCBSMT
MT0000000372OtherBCBSMT