Provider Demographics
NPI:1972513638
Name:NORTHERN CHEYENNE TRIBE
Entity type:Organization
Organization Name:NORTHERN CHEYENNE TRIBE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:3RD PARTY BILLING CLERK
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:LARANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-477-4911
Mailing Address - Street 1:22 NORTH CHEYENNE AVE
Mailing Address - Street 2:PO BOX 67
Mailing Address - City:LAME DEER
Mailing Address - State:MT
Mailing Address - Zip Code:59043-0067
Mailing Address - Country:US
Mailing Address - Phone:406-477-6775
Mailing Address - Fax:406-477-6083
Practice Address - Street 1:22 NORTH CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043-0067
Practice Address - Country:US
Practice Address - Phone:406-477-6775
Practice Address - Fax:406-477-6083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN CHEYENNE TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-08
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT087341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0191-2OtherBLUECROSS BLUESHIELD OF MT
MT0445263Medicaid
MT011002659OtherMEDICARE PTAN - NORIDIAN