Provider Demographics
NPI:1740464916
Name:MCCONE COUNTY HEALTH CENTER INC
Entity type:Organization
Organization Name:MCCONE COUNTY HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-485-2063
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:CIRCLE
Mailing Address - State:MT
Mailing Address - Zip Code:59215-0278
Mailing Address - Country:US
Mailing Address - Phone:406-485-2063
Mailing Address - Fax:
Practice Address - Street 1:605 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:CIRCLE
Practice Address - State:MT
Practice Address - Zip Code:59215-0278
Practice Address - Country:US
Practice Address - Phone:406-485-2063
Practice Address - Fax:406-485-2435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT40363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT81265Medicare PIN