Provider Demographics
NPI:1558302018
Name:ST. VINCENT HEALTHCARE
Entity type:Organization
Organization Name:ST. VINCENT HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOVELESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-237-3071
Mailing Address - Street 1:2900 12TH AVENUE NORTH
Mailing Address - Street 2:SUITE 201E
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7503
Mailing Address - Country:US
Mailing Address - Phone:406-237-7125
Mailing Address - Fax:406-237-7190
Practice Address - Street 1:2900 12TH AVENUE NORTH
Practice Address - Street 2:SUITE 201E
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7503
Practice Address - Country:US
Practice Address - Phone:406-237-7125
Practice Address - Fax:406-237-7190
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-08
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9717208100000X
MT13258208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000083822Medicare ID - Type Unspecified