Basic Information
| Provider Information | |||||||||
| NPI: | 1003245176 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | YELLOWSTONE CITY COUNTY HEALTH DEPARTMENT | ||||||||
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| OtherOrganizationName: | RIVERSTONE HEALTH LIL ANDERSON CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 S 27TH ST | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591014227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062473200 | ||||||||
| FaxNumber: | 4062473202 | ||||||||
| Practice Location | |||||||||
| Address1: | 2626 1ST AVE S | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591014228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062473200 | ||||||||
| FaxNumber: | 4062473202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2013 | ||||||||
| LastUpdateDate: | 01/27/2022 | ||||||||
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| AuthorizedOfficialLastName: | RITZ | ||||||||
| AuthorizedOfficialFirstName: | SHELLI | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE VP & CFO | ||||||||
| AuthorizedOfficialTelephone: | 4062473200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 01/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.