Provider Demographics
NPI:1952554578
Name:ROCKY BOY HEALTH CLINIC
Entity Type:Organization
Organization Name:ROCKY BOY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIABETES COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:406-395-4064
Mailing Address - Street 1:RR 1 BOX 664
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:MONTANA
Mailing Address - Zip Code:59521
Mailing Address - Country:UM
Mailing Address - Phone:406-395-4064
Mailing Address - Fax:406-395-4418
Practice Address - Street 1:RR 1 BOX 664
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:MT
Practice Address - Zip Code:59521-9797
Practice Address - Country:US
Practice Address - Phone:406-395-4064
Practice Address - Fax:406-395-4418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN20314261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care