Provider Demographics
NPI:1942854757
Name:MARCUS DALY MEMORIAL HOSPITAL CORP
Entity Type:Organization
Organization Name:MARCUS DALY MEMORIAL HOSPITAL CORP
Other - Org Name:BITTERROOT HEALTH-DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-363-2211
Mailing Address - Street 1:1224 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2338
Mailing Address - Country:US
Mailing Address - Phone:406-375-4824
Mailing Address - Fax:
Practice Address - Street 1:1103 WESTWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2342
Practice Address - Country:US
Practice Address - Phone:406-375-2949
Practice Address - Fax:406-375-2954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARCUS DALY MEMORIAL HOSPITAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-30
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty