Provider Demographics
NPI:1386611747
Name:POWDER RIVER COUNTY
Entity type:Organization
Organization Name:POWDER RIVER COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KESA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-436-2646
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:104 N. TRAUTMAN
Mailing Address - City:BROADUS
Mailing Address - State:MT
Mailing Address - Zip Code:59317-0719
Mailing Address - Country:US
Mailing Address - Phone:406-436-2646
Mailing Address - Fax:406-436-2923
Practice Address - Street 1:104 N. TRAUTMAN STREET
Practice Address - Street 2:BOX 719
Practice Address - City:BROADUS
Practice Address - State:MT
Practice Address - Zip Code:59317-0719
Practice Address - Country:US
Practice Address - Phone:406-436-2646
Practice Address - Fax:406-436-2923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MT10072314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT275087Medicare PIN
MT275087Medicare Oscar/Certification