Provider Demographics
NPI:1891159877
Name:POWELL COUNTY MEMORIAL HOSPITAL ASSOCIATION INC
Entity Type:Organization
Organization Name:POWELL COUNTY MEMORIAL HOSPITAL ASSOCIATION INC
Other - Org Name:DEER LODGE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAENA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-846-2212
Mailing Address - Street 1:1100 HOLLENBACK LN.
Mailing Address - Street 2:
Mailing Address - City:DEER LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59722
Mailing Address - Country:US
Mailing Address - Phone:406-846-2212
Mailing Address - Fax:406-846-2789
Practice Address - Street 1:1100 HOLLENBACK LN.
Practice Address - Street 2:
Practice Address - City:DEER LODGE
Practice Address - State:MT
Practice Address - Zip Code:59722
Practice Address - Country:US
Practice Address - Phone:406-846-2212
Practice Address - Fax:406-846-2789
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POWELL COUNTY MEMORIAL HOSPITAL ASSOCIAT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access