Provider Demographics
NPI:1629635115
Name:COUNTRY HOME MEDICINE
Entity Type:Organization
Organization Name:COUNTRY HOME MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREIHAHN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:406-778-7750
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:PLEVNA
Mailing Address - State:MT
Mailing Address - Zip Code:59344-0004
Mailing Address - Country:US
Mailing Address - Phone:406-778-7750
Mailing Address - Fax:406-772-5949
Practice Address - Street 1:104 4TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:PLEVNA
Practice Address - State:MT
Practice Address - Zip Code:59344
Practice Address - Country:US
Practice Address - Phone:406-778-7750
Practice Address - Fax:406-772-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care