Provider Demographics
NPI:1598810186
Name:BLACKFOOT VALLEY MEDICAL SERVICES CORPORATION
Entity Type:Organization
Organization Name:BLACKFOOT VALLEY MEDICAL SERVICES CORPORATION
Other - Org Name:BVMSA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:MS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRYOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-362-4603
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MT
Mailing Address - Zip Code:59639-0602
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HIGHWAY 200 WEST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MT
Practice Address - Zip Code:59639
Practice Address - Country:US
Practice Address - Phone:406-362-4603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service