Provider Demographics
NPI:1598802332
Name:ROCKY BOY HEALTH CENTER
Entity type:Organization
Organization Name:ROCKY BOY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:STIFFARM-ROSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-395-1606
Mailing Address - Street 1:6850 UPPER BOX ELDER RD
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:MT
Mailing Address - Zip Code:59521-9073
Mailing Address - Country:US
Mailing Address - Phone:406-395-1606
Mailing Address - Fax:406-395-1827
Practice Address - Street 1:6850 UPPER BOX ELDER RD
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:MT
Practice Address - Zip Code:59521-9073
Practice Address - Country:US
Practice Address - Phone:406-395-1617
Practice Address - Fax:406-395-4408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY BOY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QD0000X, 253Z00000X, 344600000X
MT271808261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No253Z00000XAgenciesIn Home Supportive Care
No344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2706402OtherNCPDP
MT2210091Medicaid
MT2706402OtherNCPDP
MT449254Medicaid
MT520351Medicaid
MT4709705Medicaid
MTP67991Medicare UPIN
MT2210091Medicaid
MTH58771Medicare UPIN
MTU68233Medicare UPIN
MTG78010Medicare UPIN
MT520351Medicaid
MT4709705Medicaid
MTU68233Medicare UPIN
MT4709705Medicaid