Provider Demographics
NPI:1942241401
Name:ST. VINCENT HEALTHCARE
Entity Type:Organization
Organization Name:ST. VINCENT HEALTHCARE
Other - Org Name:MOUNTAIN VIEW CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-237-3070
Mailing Address - Street 1:10 ROBINSON LN
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-9010
Mailing Address - Country:US
Mailing Address - Phone:406-446-3800
Mailing Address - Fax:406-446-3802
Practice Address - Street 1:10 ROBINSON LN
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-9010
Practice Address - Country:US
Practice Address - Phone:406-446-3800
Practice Address - Fax:406-446-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9717261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000008338Medicare PIN