Provider Demographics
NPI:1407212871
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:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-867-4141
Mailing Address - Street 1:10 4TH ST W
Mailing Address - Street 2:SUITE B
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-1802
Mailing Address - Country:US
Mailing Address - Phone:406-867-4141
Mailing Address - Fax:406-294-0040
Practice Address - Street 1:10 4TH ST W
Practice Address - Street 2:SUITE B
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-1802
Practice Address - Country:US
Practice Address - Phone:406-867-4141
Practice Address - Fax:406-294-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-14
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MT352823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2157576OtherPK
MT1407212871Medicaid