Provider Demographics
NPI:1538131172
Name:NORTHERN MONTANA HOSPITAL
Entity Type:Organization
Organization Name:NORTHERN MONTANA HOSPITAL
Other - Org Name:NORTHERN MONTANA FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-262-1302
Mailing Address - Street 1:PO BOX 1231
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-1231
Mailing Address - Country:US
Mailing Address - Phone:406-262-1302
Mailing Address - Fax:406-265-1651
Practice Address - Street 1:1410 1ST AVE
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-6207
Practice Address - Country:US
Practice Address - Phone:406-265-5408
Practice Address - Fax:406-265-1651
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN MONTANA HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-07
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
MT261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0720512Medicaid
MTCU0829OtherMEDICARE RAILROAD GROUP
MT000064732OtherBLUE CROSS BLUE SHIELD
000081235Medicare PIN
MT000064732OtherBLUE CROSS BLUE SHIELD