Provider Demographics
NPI:1831196393
Name:GALLATIN COUNTY
Entity type:Organization
Organization Name:GALLATIN COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DARCEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-582-3304
Mailing Address - Street 1:1221 DURSTON RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-2725
Mailing Address - Country:US
Mailing Address - Phone:406-582-3300
Mailing Address - Fax:406-582-3333
Practice Address - Street 1:1221 DURSTON RD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-2725
Practice Address - Country:US
Practice Address - Phone:406-582-3300
Practice Address - Fax:406-582-3333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 314000000X
MT9959314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0316836Medicaid
MT27-5066Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER