Provider Demographics
NPI:1114737970
Name:FORT PECK TRIBES
Entity type:Organization
Organization Name:FORT PECK TRIBES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRIBAL HEALTH SERVICE UNIT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FOUR BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-768-5790
Mailing Address - Street 1:PO BOX 1027
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-1027
Mailing Address - Country:US
Mailing Address - Phone:406-768-5790
Mailing Address - Fax:
Practice Address - Street 1:701 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255
Practice Address - Country:US
Practice Address - Phone:406-768-6003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORT PECK TRIBES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)