Provider Demographics
NPI:1598802332
Name:ROCKY BOY HEALTH CENTER
Entity type:Organization
Organization Name:ROCKY BOY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:STIFFARM-ROSETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-395-1606
Mailing Address - Street 1:6850 UPPER BOX ELDER RD
Mailing Address - Street 2:
Mailing Address - City:BOX ELDER
Mailing Address - State:MT
Mailing Address - Zip Code:59521-9073
Mailing Address - Country:US
Mailing Address - Phone:406-395-1606
Mailing Address - Fax:406-395-1827
Practice Address - Street 1:6850 UPPER BOX ELDER RD
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:MT
Practice Address - Zip Code:59521-9073
Practice Address - Country:US
Practice Address - Phone:406-395-1617
Practice Address - Fax:406-395-4408
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY BOY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-31
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
344600000X, 261QD0000X
MT271808261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No344600000XTransportation ServicesTaxi
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2706402OtherNCPDP
MT2210091Medicaid
MT2706402OtherNCPDP
MT449254Medicaid
MT520351Medicaid
MT4709705Medicaid
MTP67991Medicare UPIN
MT2210091Medicaid
MTH58771Medicare UPIN
MTU68233Medicare UPIN
MTG78010Medicare UPIN
MT520351Medicaid
MT4709705Medicaid
MTU68233Medicare UPIN
MT4709705Medicaid