Provider Demographics
NPI:1659580975
Name:COUNTY OF CUSTER
Entity Type:Organization
Organization Name:COUNTY OF CUSTER
Other - Org Name:CUSTER COUNTY HEALTH DEPARTMENT AND FAMILY PLANNING
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:406-874-3377
Mailing Address - Street 1:2000 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-2726
Mailing Address - Country:US
Mailing Address - Phone:406-874-3377
Mailing Address - Fax:406-874-3459
Practice Address - Street 1:2000 CLARK ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-2726
Practice Address - Country:US
Practice Address - Phone:406-874-3377
Practice Address - Fax:406-874-3459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN24294251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3504956Medicaid
MT000003579Medicare PIN