Provider Demographics
NPI:1588843304
Name:MISSOURI RIVER HEALTHCARE
Entity Type:Organization
Organization Name:MISSOURI RIVER HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LADONNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:406-761-5252
Mailing Address - Street 1:PO BOX 7167
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-7167
Mailing Address - Country:US
Mailing Address - Phone:406-761-5252
Mailing Address - Fax:406-761-3626
Practice Address - Street 1:926 13TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4406
Practice Address - Country:US
Practice Address - Phone:406-761-5252
Practice Address - Fax:406-761-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN23096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4306338Medicaid
MT000375060OtherBLUE CROSS