Provider Demographics
NPI:1619160504
Name:BIGHORN VALLEY HEALTH CENTER INCORPORATED
Entity Type:Organization
Organization Name:BIGHORN VALLEY HEALTH CENTER INCORPORATED
Other - Org Name:ONE HEALTH-HARLEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-665-4103
Mailing Address - Street 1:207 W MAIN ST STE 5
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2718
Mailing Address - Country:US
Mailing Address - Phone:406-357-2294
Mailing Address - Fax:406-357-3252
Practice Address - Street 1:530 CENTRAL AVE W
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526-8078
Practice Address - Country:US
Practice Address - Phone:406-353-4861
Practice Address - Fax:406-353-2721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT271830Medicare Oscar/Certification
MT00008387Medicare PIN
MT0631790001Medicare NSC