Provider Demographics
NPI:1932116340
Name:STATE OF MONTANA
Entity Type:Organization
Organization Name:STATE OF MONTANA
Other - Org Name:MONTANA STATE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FISCAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-444-4497
Mailing Address - Street 1:111 N SANDERS ST DEPT 30
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4520
Mailing Address - Country:US
Mailing Address - Phone:406-444-4497
Mailing Address - Fax:406-444-3082
Practice Address - Street 1:300 GARNET WAY
Practice Address - Street 2:
Practice Address - City:WARM SPRINGS
Practice Address - State:MT
Practice Address - Zip Code:59756-0300
Practice Address - Country:US
Practice Address - Phone:406-693-7021
Practice Address - Fax:406-693-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10419283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT57-2286Medicaid
MT570044Medicaid
MTM000009901Medicare PIN
MT274086Medicare ID - Type Unspecified
MT570044Medicaid
MT000003385Medicare PIN