Provider Demographics
NPI:1770641383
Name:STILLWATER HOSPITAL ASSOCIATION, INC.
Entity Type:Organization
Organization Name:STILLWATER HOSPITAL ASSOCIATION, INC.
Other - Org Name:STILLWATER COMMUNITY HOSPITAL ECU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOBOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-322-1000
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MT
Mailing Address - Zip Code:59019-0959
Mailing Address - Country:US
Mailing Address - Phone:406-322-5316
Mailing Address - Fax:406-322-5207
Practice Address - Street 1:44 W 4TH AVE N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019-0959
Practice Address - Country:US
Practice Address - Phone:406-322-5316
Practice Address - Fax:406-322-5207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10073313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT311844Medicaid