Basic Information
| Provider Information | |||||||||
| NPI: | 1225201825 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOLY ROSARY HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 WILSON ST. | ||||||||
| Address2: | |||||||||
| City: | MILES CITY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 593015094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062332600 | ||||||||
| FaxNumber: | 3032720390 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 WILSON ST | ||||||||
| Address2: | |||||||||
| City: | MILES CITY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 593015094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062332500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2008 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | PALAGI | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4067232414 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. | ||||||||
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| NPICertificationDate: | 04/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 1548292220 | 05 | MT | MEDICAID |