Provider Demographics
NPI:1992722904
Name:WOLF POINT CLINIC ASSOCIATION INC
Entity type:Organization
Organization Name:WOLF POINT CLINIC ASSOCIATION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:B
Authorized Official - Last Name:NORGAARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-653-6512
Mailing Address - Street 1:301 KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-1826
Mailing Address - Country:US
Mailing Address - Phone:406-653-2150
Mailing Address - Fax:406-653-6591
Practice Address - Street 1:301 KNAPP ST
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-1826
Practice Address - Country:US
Practice Address - Phone:406-653-2150
Practice Address - Fax:406-653-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2018-06-11
Deactivation Date:2018-05-16
Deactivation Code:
Reactivation Date:2018-06-11
Provider Licenses
StateLicense IDTaxonomies
MT261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0720154Medicaid
MT273992Medicare Oscar/Certification
MT0720154Medicaid