Provider Demographics
NPI:1568583391
Name:HI-LINE MEDICAL SERVICES
Entity Type:Organization
Organization Name:HI-LINE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:G
Authorized Official - Last Name:HOLOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-228-3601
Mailing Address - Street 1:621 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-2604
Mailing Address - Country:US
Mailing Address - Phone:406-228-3536
Mailing Address - Fax:406-228-3537
Practice Address - Street 1:621 3RD ST S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2604
Practice Address - Country:US
Practice Address - Phone:406-228-3536
Practice Address - Fax:406-228-3537
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRANCES MAHON DEACONESS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-02
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11017207X00000X
207X00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DG9848OtherRR MCR GROUP
011001258Medicare PIN