Provider Demographics
NPI:1922073907
Name:GRANITE COUNTY HOSPITAL DISTRICT
Entity Type:Organization
Organization Name:GRANITE COUNTY HOSPITAL DISTRICT
Other - Org Name:GRANITE COUNTY MEDICAL CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/DON
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:STOPPLER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:406-859-3271
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:PHILIPSBURG
Mailing Address - State:MT
Mailing Address - Zip Code:59858-0729
Mailing Address - Country:US
Mailing Address - Phone:406-859-3271
Mailing Address - Fax:409-859-3011
Practice Address - Street 1:310 SOUTH SANSOME STREET
Practice Address - Street 2:
Practice Address - City:PHILIPSBURG
Practice Address - State:MT
Practice Address - Zip Code:59858-0729
Practice Address - Country:US
Practice Address - Phone:406-859-3271
Practice Address - Fax:409-859-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11197282NC0060X
MT11918282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
271303Medicare Oscar/Certification
MT27Z303Medicare Oscar/Certification
MT271303Medicare Oscar/Certification
MT000009979Medicare PIN
MT273400Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC
M0000099979Medicare PIN