Provider Demographics
NPI:1851791750
Name:POWDER RIVER COUNTY
Entity Type:Organization
Organization Name:POWDER RIVER COUNTY
Other - Org Name:POWDER RIVER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMMISSIONER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:RANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-436-2361
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:507 NORTH LINCOLN AVE
Mailing Address - City:BROADUS
Mailing Address - State:MT
Mailing Address - Zip Code:59317-0489
Mailing Address - Country:US
Mailing Address - Phone:406-436-2651
Mailing Address - Fax:406-436-2652
Practice Address - Street 1:507 NORTH LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BROADUS
Practice Address - State:MT
Practice Address - Zip Code:59317-0489
Practice Address - Country:US
Practice Address - Phone:406-436-2651
Practice Address - Fax:406-436-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service