Provider Demographics
NPI:1619970795
Name:BIGHORN VALLEY HEALTH CENTER INCORPORATED
Entity Type:Organization
Organization Name:BIGHORN VALLEY HEALTH CENTER INCORPORATED
Other - Org Name:ONE HEALTH-SWEET/CHINOOK
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:
Authorized Official - Phone:406-665-4103
Mailing Address - Street 1:10 4TH ST W
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-1802
Mailing Address - Country:US
Mailing Address - Phone:406-357-2403
Mailing Address - Fax:406-357-3252
Practice Address - Street 1:419 PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:CHINOOK
Practice Address - State:MT
Practice Address - Zip Code:59523-0309
Practice Address - Country:US
Practice Address - Phone:406-357-2403
Practice Address - Fax:406-357-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9791261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT730354Medicaid
MT0631790001Medicare NSC
MT271818Medicare ID - Type UnspecifiedFQHC
MT730354Medicaid