Provider Demographics
NPI:1386751196
Name:ROUNDUP MEMORIAL HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:ROUNDUP MEMORIAL HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-323-2301
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:ROUNDUP
Mailing Address - State:MT
Mailing Address - Zip Code:59072-0040
Mailing Address - Country:US
Mailing Address - Phone:406-323-2301
Mailing Address - Fax:406-323-3002
Practice Address - Street 1:1203 THIRD ST W
Practice Address - Street 2:
Practice Address - City:ROUNDUP
Practice Address - State:MT
Practice Address - Zip Code:59072-0040
Practice Address - Country:US
Practice Address - Phone:406-323-3201
Practice Address - Fax:406-323-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11708282NC0060X, 282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0418379Medicaid
MT271346Medicare Oscar/Certification
MT000009980Medicare PIN
MT270081Medicare ID - Type UnspecifiedPART A AND PART B