Provider Demographics
NPI:1790869535
Name:PONDERA MEDICAL CENTER RURAL HEALTH CLINIC
Entity Type:Organization
Organization Name:PONDERA MEDICAL CENTER RURAL HEALTH CLINIC
Other - Org Name:PONDERA MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JIM
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-271-3211
Mailing Address - Street 1:805 SUNSET BLVD.
Mailing Address - Street 2:PO BOX 758
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425-0758
Mailing Address - Country:US
Mailing Address - Phone:406-271-3211
Mailing Address - Fax:406-271-3917
Practice Address - Street 1:805 SUNSET BLVD.
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-0758
Practice Address - Country:US
Practice Address - Phone:406-271-3211
Practice Address - Fax:406-271-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health