Basic Information
Provider Information | |||||||||
NPI: | 1093028532 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | SCL HEALTH MONTANA | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | SVH ORTHOPEDIC CLINIC | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2900 12TH AVE N | ||||||||
Address2: | SUITE 100E &140W | ||||||||
City: | BILLINGS | ||||||||
State: | MT | ||||||||
PostalCode: | 591017506 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4062375050 | ||||||||
FaxNumber: | 4062386599 | ||||||||
Practice Location | |||||||||
Address1: | 2900 12TH AVE N | ||||||||
Address2: | SUITE 100E &140W | ||||||||
City: | BILLINGS | ||||||||
State: | MT | ||||||||
PostalCode: | 591017506 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4062375050 | ||||||||
FaxNumber: | 4062386599 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/26/2010 | ||||||||
LastUpdateDate: | 11/24/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PALAGI | ||||||||
AuthorizedOfficialFirstName: | PAM | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
AuthorizedOfficialTelephone: | 4067232414 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/24/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | 12129 | MT | Y |   | Ambulatory Health Care Facilities | Clinic/Center |   |
ID Information
ID | Type | State | Issuer | Description | 4062375050 | 01 | MT | PHONE NUMBER | OTHER |