Provider Demographics
NPI:1902962103
Name:ANACONDA DEER LODGE COUNTY
Entity type:Organization
Organization Name:ANACONDA DEER LODGE COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-563-7863
Mailing Address - Street 1:P.O. BOX 970
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-0970
Mailing Address - Country:US
Mailing Address - Phone:406-563-7863
Mailing Address - Fax:406-563-2387
Practice Address - Street 1:118 E 7TH ST STE 1E
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2953
Practice Address - Country:US
Practice Address - Phone:406-563-7863
Practice Address - Fax:406-563-2387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANACONDA DEER LODGE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT290329OtherMIAMI TARGETED CASE MANAG
MT312078OtherBLUE CROSS BLUE SHEILD
MT290472OtherFOLLOWME TARGETED CASE MA
MT3505931Medicaid
MT000003630Medicare ID - Type Unspecified