Provider Demographics
NPI:1558482935
Name:CONFEDERATED SALISH & KOOTENAI TRIBES OF THE FLATHEAD RESERVATION
Entity Type:Organization
Organization Name:CONFEDERATED SALISH & KOOTENAI TRIBES OF THE FLATHEAD RESERVATION
Other - Org Name:POLSON TRIBAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DURGLO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:406-745-3525
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:308 MISSION DR
Mailing Address - City:ST IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5 4TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-2117
Practice Address - Country:US
Practice Address - Phone:406-675-2700
Practice Address - Fax:406-745-4095
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONFEDERATED SALISH & KOOTENAI TRIBES OF THE FLATHEAD RESERVATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-03
Last Update Date:2023-02-13
Deactivation Date:2007-06-08
Deactivation Code:
Reactivation Date:2017-08-15
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332800000XSuppliersIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2210104Medicaid
271810Medicare ID - Type Unspecified