Provider Demographics
NPI:1215070842
Name:COUNTY OF ROSEBUD
Entity type:Organization
Organization Name:COUNTY OF ROSEBUD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:406-346-2156
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MT
Mailing Address - Zip Code:59327-0388
Mailing Address - Country:US
Mailing Address - Phone:406-346-2156
Mailing Address - Fax:406-346-4266
Practice Address - Street 1:281 N 17TH AVE
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MT
Practice Address - Zip Code:59327-9030
Practice Address - Country:US
Practice Address - Phone:406-346-2156
Practice Address - Fax:406-346-4266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4811251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT00000107185Medicaid
MT00000107185Medicaid
MT600000777Medicare ID - Type UnspecifiedRR MEDICARE-PALMETTO GBA