Provider Demographics
NPI:1891852828
Name:PIONEER MEDICAL CENTER
Entity Type:Organization
Organization Name:PIONEER MEDICAL CENTER
Other - Org Name:PIONEER MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-932-4603
Mailing Address - Street 1:301 W 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BIG TIMBER
Mailing Address - State:MT
Mailing Address - Zip Code:59011-7893
Mailing Address - Country:US
Mailing Address - Phone:406-932-4603
Mailing Address - Fax:406-932-5468
Practice Address - Street 1:301 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:BIG TIMBER
Practice Address - State:MT
Practice Address - Zip Code:59011-7893
Practice Address - Country:US
Practice Address - Phone:406-932-4603
Practice Address - Fax:406-932-5468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10250310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0621367Medicaid