Provider Demographics
NPI:1285611129
Name:BIGHORN VALLEY HEALTH CENTER INCORPORATED
Entity type:Organization
Organization Name:BIGHORN VALLEY HEALTH CENTER INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-665-4103
Mailing Address - Street 1:305 S 4TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-4113
Mailing Address - Country:US
Mailing Address - Phone:406-234-8793
Mailing Address - Fax:406-234-8796
Practice Address - Street 1:305 S 4TH ST
Practice Address - Street 2:
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-4113
Practice Address - Country:US
Practice Address - Phone:406-874-8700
Practice Address - Fax:406-874-3459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT00862OtherBLUE CROSS
MT92708659OtherMONTANA BREAST AND CERVIC
MT0730422Medicaid
MT92708659OtherMONTANA BREAST AND CERVIC
MT000083717Medicare ID - Type UnspecifiedPART B PROVIDER