Provider Demographics
NPI:1588720882
Name:ST. JOHN'S LUTHERAN HOSPITAL, INC.
Entity type:Organization
Organization Name:ST. JOHN'S LUTHERAN HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-283-7219
Mailing Address - Street 1:209 HEALTH PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2001
Mailing Address - Country:US
Mailing Address - Phone:406-283-7000
Mailing Address - Fax:406-293-3895
Practice Address - Street 1:209 HEALTH PARK DR
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2001
Practice Address - Country:US
Practice Address - Phone:406-283-7000
Practice Address - Fax:406-293-3895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10828275N00000X
MT11971275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3100006Medicaid
MT3100006Medicaid
27Z320Medicare Oscar/Certification