Provider Demographics
NPI:1841356748
Name:GALLATIN COUNTY
Entity type:Organization
Organization Name:GALLATIN COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:D
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:406-582-3100
Mailing Address - Street 1:311 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-4594
Mailing Address - Country:US
Mailing Address - Phone:406-582-3100
Mailing Address - Fax:406-582-3112
Practice Address - Street 1:215 W MENDENHALL ST STE 117
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3401
Practice Address - Country:US
Practice Address - Phone:406-582-3100
Practice Address - Fax:406-582-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT251B00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT290056Medicaid
MT290576Medicaid
MT3500939Medicaid
MT290628Medicaid
MT31528OtherBCBS PROVIDER #
MT290056Medicaid
MT990001053Medicare ID - Type UnspecifiedRAILRD MEDICARE ROSTER