Provider Demographics
NPI:1780764274
Name:GLACIER COMMUNITY HEALTH CENTER INC
Entity type:Organization
Organization Name:GLACIER COMMUNITY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-873-5670
Mailing Address - Street 1:519 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CUT BANK
Mailing Address - State:MT
Mailing Address - Zip Code:59427-3015
Mailing Address - Country:US
Mailing Address - Phone:406-873-5670
Mailing Address - Fax:406-873-5675
Practice Address - Street 1:519 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUT BANK
Practice Address - State:MT
Practice Address - Zip Code:59427-3015
Practice Address - Country:US
Practice Address - Phone:406-873-5670
Practice Address - Fax:406-873-5675
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLACIER COMMUNITY HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-17
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT174400000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT67332OtherBLUE CROSS
MT000084542OtherMEDICARE PART B
MT730418Medicaid
MT271823Medicare Oscar/Certification