Provider Demographics
NPI:1811016652
Name:ST JOSEPH HOSPITAL CORPORATION
Entity Type:Organization
Organization Name:ST JOSEPH HOSPITAL CORPORATION
Other - Org Name:WESTERN MONTANA MEDICAL CLINIC-POLSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-883-8913
Mailing Address - Street 1:PO BOX 1010
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-1010
Mailing Address - Country:US
Mailing Address - Phone:406-883-8933
Mailing Address - Fax:406-883-8910
Practice Address - Street 1:6 13TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-5315
Practice Address - Country:US
Practice Address - Phone:406-883-8933
Practice Address - Fax:406-883-8254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000085139Medicare ID - Type Unspecified
000085139Medicare PIN