Provider Demographics
NPI:1700935368
Name:DAHL MEMORIAL HEALTHCARE ASSOCIATION INC
Entity Type:Organization
Organization Name:DAHL MEMORIAL HEALTHCARE ASSOCIATION INC
Other - Org Name:DAHL MEMORIAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOOKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-775-8739
Mailing Address - Street 1:PO BOX 46
Mailing Address - Street 2:
Mailing Address - City:EKALAKA
Mailing Address - State:MT
Mailing Address - Zip Code:59324-0046
Mailing Address - Country:US
Mailing Address - Phone:406-775-8738
Mailing Address - Fax:406-775-6479
Practice Address - Street 1:106 E PARK ST
Practice Address - Street 2:
Practice Address - City:EKALAKA
Practice Address - State:MT
Practice Address - Zip Code:59324-0046
Practice Address - Country:US
Practice Address - Phone:406-775-8730
Practice Address - Fax:406-775-6479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1700935368Medicaid
MT273976Medicare Oscar/Certification