Provider Demographics
NPI:1023253044
Name:MARCUS DALY MEMORIAL HOSPITAL CORPORATION
Entity type:Organization
Organization Name:MARCUS DALY MEMORIAL HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DONJA
Authorized Official - Middle Name:C
Authorized Official - Last Name:ERDMAN
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:406-375-4823
Mailing Address - Fax:406-375-4846
Practice Address - Street 1:1150 WESTWOOD DR
Practice Address - Street 2:SUITE C
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-5318
Practice Address - Country:US
Practice Address - Phone:406-363-4574
Practice Address - Fax:406-363-4769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1023253044Medicaid
ID1023253044Medicaid
MT1023253044Medicaid