Provider Demographics
NPI:1427844588
Name:CLARK FORK HEALTHCARE, LLC
Entity type:Organization
Organization Name:CLARK FORK HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-207-2726
Mailing Address - Street 1:205 HAGGERTY LN STE 260
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8801
Mailing Address - Country:US
Mailing Address - Phone:406-551-2273
Mailing Address - Fax:406-551-2073
Practice Address - Street 1:205 HAGGERTY LN STE 260
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8801
Practice Address - Country:US
Practice Address - Phone:406-551-2273
Practice Address - Fax:406-551-2073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based