Provider Demographics
NPI:1750459715
Name:CENTRAL MONTANA MEDICAL FACILITIES, INC.
Entity Type:Organization
Organization Name:CENTRAL MONTANA MEDICAL FACILITIES, INC.
Other - Org Name:CENTRAL MONTANA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-535-7711
Mailing Address - Street 1:408 WENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2261
Mailing Address - Country:US
Mailing Address - Phone:406-535-7711
Mailing Address - Fax:406-535-6392
Practice Address - Street 1:408 WENDELL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2261
Practice Address - Country:US
Practice Address - Phone:406-535-7711
Practice Address - Fax:406-535-6392
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL MONTANA MEDICAL FACILITIES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-30
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0410163Medicaid
MT05331OtherBCBS OF MT
MT0410163Medicaid
MT=========594570000OtherTRICARE PROVIDER NO.
MT=========594570000OtherTRICARE PROVIDER NO.