Provider Demographics
NPI:1609020080
Name:FORT PECK TRIBES
Entity Type:Organization
Organization Name:FORT PECK TRIBES
Other - Org Name:FORT PECK TRIBAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRIBAL HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ERVIN
Authorized Official - Last Name:FOUR BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MASTER BUSINESS
Authorized Official - Phone:406-768-2200
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-1027
Mailing Address - Country:US
Mailing Address - Phone:406-768-2200
Mailing Address - Fax:406-768-5780
Practice Address - Street 1:107 H ST
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255-7817
Practice Address - Country:US
Practice Address - Phone:406-768-2200
Practice Address - Fax:406-768-5780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X, 261QF0400X, 344600000X
MTG31-0030P343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No344600000XTransportation ServicesTaxi