Provider Demographics
NPI:1255351862
Name:RIVERSIDE FAMILY CLINIC
Entity type:Organization
Organization Name:RIVERSIDE FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:B
Authorized Official - Last Name:NORGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-768-6133
Mailing Address - Street 1:209 1/2 H ST EAST
Mailing Address - Street 2:PO BOX 629
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-0629
Mailing Address - Country:US
Mailing Address - Phone:406-768-5171
Mailing Address - Fax:406-768-6161
Practice Address - Street 1:209 H ST EAST
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255-0629
Practice Address - Country:US
Practice Address - Phone:406-768-5171
Practice Address - Fax:406-768-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2018-06-11
Deactivation Date:2018-05-16
Deactivation Code:
Reactivation Date:2018-06-11
Provider Licenses
StateLicense IDTaxonomies
MT261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0720137Medicaid
MT0720137Medicaid
MT273993Medicare Oscar/Certification