Provider Demographics
NPI:1386719656
Name:SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC
Entity type:Organization
Organization Name:SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHARMACY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-284-1004
Mailing Address - Street 1:435 S CRYSTAL ST
Mailing Address - Street 2:STE 230
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1506
Mailing Address - Country:US
Mailing Address - Phone:406-723-2441
Mailing Address - Fax:406-723-2799
Practice Address - Street 1:435 S CRYSTAL ST
Practice Address - Street 2:STE 230
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1506
Practice Address - Country:US
Practice Address - Phone:406-723-2441
Practice Address - Fax:406-723-2799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0002X, 3336I0012X
MT12133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2052603OtherPK
MT0215101Medicaid
MT5608028Medicaid
3832220001Medicare NSC
2052603OtherPK