Provider Demographics
NPI:1629389705
Name:ST PATRICK HOSP & HEALTH SCI CTR
Entity Type:Organization
Organization Name:ST PATRICK HOSP & HEALTH SCI CTR
Other - Org Name:MISSION VALLEY HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:RCM OPERATIONS MGR
Authorized Official - Prefix:
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-329-5795
Mailing Address - Street 1:PO BOX 34439
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1439
Mailing Address - Country:US
Mailing Address - Phone:406-329-5795
Mailing Address - Fax:
Practice Address - Street 1:35773 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ST IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-9001
Practice Address - Country:US
Practice Address - Phone:406-745-8765
Practice Address - Fax:406-745-8768
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST PATRICK HOSP & HEALTH SCI CTR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-23
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM000009936Medicare PIN