Provider Demographics
NPI:1528167905
Name:BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC
Entity type:Organization
Organization Name:BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:J
Authorized Official - Last Name:STERGAR
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:406-723-4075
Mailing Address - Street 1:445 CENTENNIAL AVE
Mailing Address - Street 2:SHERIDAN COMMUNITY HEALTH CENTER
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2870
Mailing Address - Country:US
Mailing Address - Phone:406-723-4075
Mailing Address - Fax:406-496-6035
Practice Address - Street 1:317 MADISON
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:MT
Practice Address - Zip Code:59749-0245
Practice Address - Country:US
Practice Address - Phone:406-842-5103
Practice Address - Fax:406-842-5110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BUTTE SILVER PRIMARY HEALTH CARE CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO95608222OtherMT BREAST & CERVICAL PROG
MT0730028Medicaid
MT63392OtherBCBS
MTCK5130OtherRAILROAD MEDICARE
MO95608222OtherMT BREAST & CERVICAL PROG
MTCK5130OtherRAILROAD MEDICARE