Basic Information
| Provider Information | |||||||||
| NPI: | 1093876344 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. LUKES COMMUNITY HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST. LUKE COMMUNITY CLINIC RONAN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 6TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | RONAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598642634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066764441 | ||||||||
| FaxNumber: | 4066760835 | ||||||||
| Practice Location | |||||||||
| Address1: | 126 6TH AVE SW | ||||||||
| Address2: | |||||||||
| City: | RONAN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598642600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066763600 | ||||||||
| FaxNumber: | 4066763738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 09/28/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CLAIRMONT | ||||||||
| AuthorizedOfficialFirstName: | LIANE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 4066764441 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 2084P0800X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.