Provider Demographics
NPI:1659475846
Name:MARCUS DALY MEMORIAL HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:MARCUS DALY MEMORIAL HOSPITAL CORPORATION
Other - Org Name:BITTERROOT HEALTH-DALY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-363-2211
Mailing Address - Street 1:1200 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2395
Mailing Address - Country:US
Mailing Address - Phone:406-363-2211
Mailing Address - Fax:406-363-6536
Practice Address - Street 1:1200 WESTWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2395
Practice Address - Country:US
Practice Address - Phone:406-363-2211
Practice Address - Fax:406-363-6536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10168282NC0060X
MT11372282NC0060X, 332B00000X
MT12139332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002197100Medicaid
MT4103018Medicaid
WA7077530Medicaid
ID002197100Medicaid
MT4103018Medicaid
MT0619410003Medicare NSC
WA7077530Medicaid