Provider Demographics
NPI:1841347101
Name:COUNTY OF LINCOLN
Entity type:Organization
Organization Name:COUNTY OF LINCOLN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCULLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-283-2465
Mailing Address - Street 1:418 MINERAL AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-1956
Mailing Address - Country:US
Mailing Address - Phone:406-283-2442
Mailing Address - Fax:406-283-2466
Practice Address - Street 1:418 MINERAL AVE
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-1956
Practice Address - Country:US
Practice Address - Phone:406-283-2442
Practice Address - Fax:406-283-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN12411251K00000X
261Q00000X, 261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No251K00000XAgenciesPublic Health or Welfare
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT31228OtherBLUE CROSS BLUE SHIELD
MT0000031228OtherMONTANA BLUE CHIP
MT600001652OtherRAILROAD MEDICARE
MT3505658Medicaid
MT0000031228OtherMONTANA BLUE CHIP
MT=========326526002OtherTRICARE
MT000003375Medicare ID - Type UnspecifiedPROVIDER NUMBER
MT3505658Medicaid