Provider Demographics
NPI:1740761204
Name:BIGHORN VALLEY HEALTH CENTER INCORPORATED
Entity Type:Organization
Organization Name:BIGHORN VALLEY HEALTH CENTER INCORPORATED
Other - Org Name:BIGHORN VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-867-4141
Mailing Address - Street 1:10 4TH ST W STE B
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-1804
Mailing Address - Country:US
Mailing Address - Phone:406-867-4141
Mailing Address - Fax:
Practice Address - Street 1:10 4TH ST W STE B
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-1804
Practice Address - Country:US
Practice Address - Phone:406-867-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1407212871Medicaid