Provider Demographics
NPI:1609954759
Name:BIG SANDY MEDICAL CENTER INC
Entity Type:Organization
Organization Name:BIG SANDY MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-378-2189
Mailing Address - Street 1:PO BOX 530
Mailing Address - Street 2:
Mailing Address - City:BIG SANDY
Mailing Address - State:MT
Mailing Address - Zip Code:59520-0530
Mailing Address - Country:US
Mailing Address - Phone:406-378-2189
Mailing Address - Fax:406-378-2180
Practice Address - Street 1:166 MONTANA AVE EAST
Practice Address - Street 2:
Practice Address - City:BIG SANDY
Practice Address - State:MT
Practice Address - Zip Code:59520-0530
Practice Address - Country:US
Practice Address - Phone:406-378-2189
Practice Address - Fax:406-378-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT009901OtherBCBS HCFA
MT0720052Medicaid
MT064332OtherBCBS UB
MT009901OtherBCBS HCFA