Provider Demographics
NPI:1679847016
Name:CENTRAL MONTANA COMMUNITY HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:CENTRAL MONTANA COMMUNITY HEALTH CENTER, INC.
Other - Org Name:BASIN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-535-6545
Mailing Address - Street 1:406 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-3020
Mailing Address - Country:US
Mailing Address - Phone:406-535-6545
Mailing Address - Fax:406-535-6549
Practice Address - Street 1:94 CENTRAL AVENUE
Practice Address - Street 2:SUITE 3
Practice Address - City:STANFORD
Practice Address - State:MT
Practice Address - Zip Code:59479-0000
Practice Address - Country:US
Practice Address - Phone:406-566-2773
Practice Address - Fax:406-566-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
271846Medicare PIN