Provider Demographics
NPI:1902195027
Name:YELLOWSTONE CITY COUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:YELLOWSTONE CITY COUNTY HEALTH DEPARTMENT
Other - Org Name:RIVERSTONE HEALTH WORDEN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EVP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:RITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-247-3200
Mailing Address - Street 1:123 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-4200
Mailing Address - Country:US
Mailing Address - Phone:406-247-3200
Mailing Address - Fax:
Practice Address - Street 1:2469 MAIN ST
Practice Address - Street 2:
Practice Address - City:WORDEN
Practice Address - State:MT
Practice Address - Zip Code:59088-2227
Practice Address - Country:US
Practice Address - Phone:406-967-2255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-29
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT261QF0400XMedicaid
MT000080527OtherMEDICARE PART B PROVIDER
MT261QF0400XMedicaid