Provider Demographics
NPI:1841342011
Name:ST. JOHN'S LUTHERAN HOSPITAL, INC
Entity type:Organization
Organization Name:ST. JOHN'S LUTHERAN HOSPITAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP COMMUNITY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-283-7000
Mailing Address - Street 1:350 LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2130
Mailing Address - Country:US
Mailing Address - Phone:406-283-7000
Mailing Address - Fax:406-293-2262
Practice Address - Street 1:313 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2037
Practice Address - Country:US
Practice Address - Phone:406-283-7000
Practice Address - Fax:406-293-2262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOHN'S LUTHERAN HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-17
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10263251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT350120OtherBLUE CROSS HOSPICE
MT750142Medicaid
MT750142Medicaid