Provider Demographics
NPI:1942321120
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:C E O
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-859-3271
Mailing Address - Street 1:PO BOX 729
Mailing Address - Street 2:310 SANSOME ST
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:406-859-3011
Practice Address - Street 1:26 EAST BROAD ST
Practice Address - Street 2:
Practice Address - City:DRUMMOND
Practice Address - State:MT
Practice Address - Zip Code:59832-0312
Practice Address - Country:US
Practice Address - Phone:406-288-3627
Practice Address - Fax:406-288-3541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10614261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT273404Medicare ID - Type UnspecifiedRURAL HEALTH CLINIC