Provider Demographics
NPI:1952402208
Name:CONFEDERATED SALISH AND KOOTENAI TRIBES OF THE FLATHEAD RESERVATION
Entity Type:Organization
Organization Name:CONFEDERATED SALISH AND KOOTENAI TRIBES OF THE FLATHEAD RESERVATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:DURGLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-675-2700
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:PABLO
Mailing Address - State:MT
Mailing Address - Zip Code:59855-0278
Mailing Address - Country:US
Mailing Address - Phone:406-675-2700
Mailing Address - Fax:406-275-2806
Practice Address - Street 1:35401 MISSION DRIVE
Practice Address - Street 2:
Practice Address - City:SAINT IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-9676
Practice Address - Country:US
Practice Address - Phone:406-745-3525
Practice Address - Fax:406-745-4721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2210104Medicaid
2706438OtherNCPDP
271810Medicare ID - Type Unspecified