Provider Demographics
NPI:1770756439
Name:COUNTY OF MCCONE
Entity type:Organization
Organization Name:COUNTY OF MCCONE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOOD-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:406-485-2444
Mailing Address - Street 1:PO BOX 47
Mailing Address - Street 2:
Mailing Address - City:CIRCLE
Mailing Address - State:MT
Mailing Address - Zip Code:59215-0047
Mailing Address - Country:US
Mailing Address - Phone:406-485-2444
Mailing Address - Fax:406-485-3603
Practice Address - Street 1:605 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:CIRCLE
Practice Address - State:MT
Practice Address - Zip Code:59215-0047
Practice Address - Country:US
Practice Address - Phone:406-485-2444
Practice Address - Fax:406-485-3603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000003595Medicare PIN