Provider Demographics
NPI:1710679345
Name:BIGHORN VALLEY HEALTH CENTER, INCORPORATED
Entity Type:Organization
Organization Name:BIGHORN VALLEY HEALTH CENTER, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-665-4103
Mailing Address - Street 1:2811 COMSTOCK ST
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-5754
Mailing Address - Country:US
Mailing Address - Phone:406-874-8700
Mailing Address - Fax:
Practice Address - Street 1:2811 COMSTOCK ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-5754
Practice Address - Country:US
Practice Address - Phone:406-874-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIGHORN VALLEY HEALTH CENTER, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)