Provider Demographics
NPI:1568416717
Name:NORTHERN ROCKIES MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:NORTHERN ROCKIES MEDICAL CENTER, INC.
Other - Org Name:LOGAN HEALTH RURAL HEALTH CLINIC - CUT BANK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-873-2251
Mailing Address - Street 1:226 9TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:CUT BANK
Mailing Address - State:MT
Mailing Address - Zip Code:59427-3332
Mailing Address - Country:US
Mailing Address - Phone:406-873-5507
Mailing Address - Fax:
Practice Address - Street 1:226 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:CUT BANK
Practice Address - State:MT
Practice Address - Zip Code:59427-3332
Practice Address - Country:US
Practice Address - Phone:406-873-5507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10272261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000066312OtherBC/BS
MT0720358Medicaid
MT0720358Medicaid
MT273984Medicare Oscar/Certification
MT000009993Medicare PIN