Provider Demographics
NPI:1487724399
Name:PONDERA MEDICAL CENTER
Entity type:Organization
Organization Name:PONDERA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JIM
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-271-2202
Mailing Address - Street 1:805 SUNSET BLVD.
Mailing Address - Street 2:PO BOX 758
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425-0758
Mailing Address - Country:US
Mailing Address - Phone:406-271-2202
Mailing Address - Fax:406-271-3917
Practice Address - Street 1:805 SUNSET BLVD.
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-0758
Practice Address - Country:US
Practice Address - Phone:406-271-2202
Practice Address - Fax:406-271-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty