Provider Demographics
NPI:1659483048
Name:FORT PECK TRIBES
Entity Type:Organization
Organization Name:FORT PECK TRIBES
Other - Org Name:FORT PECK TRIBAL DIALYSIS UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUR BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-768-3491
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-1027
Mailing Address - Country:US
Mailing Address - Phone:406-768-5468
Mailing Address - Fax:406-768-5121
Practice Address - Street 1:107 H ST
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255-1027
Practice Address - Country:US
Practice Address - Phone:406-768-5468
Practice Address - Fax:406-768-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0730041Medicaid
MT272500Medicare ID - Type UnspecifiedESRD PROVIDER