Basic Information
| Provider Information | |||||||||
| NPI: | 1497414114 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BIGHORN VALLEY HEALTH CENTER INCORPORATED | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ONE HEALTH-CROW AGENCY SCHOOL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 4TH ST W | ||||||||
| Address2: | |||||||||
| City: | HARDIN | ||||||||
| State: | MT | ||||||||
| PostalCode: | 590341802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066654103 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 3RD STREET W. | ||||||||
| Address2: | |||||||||
| City: | CROW AGNECY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4066654103 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2021 | ||||||||
| LastUpdateDate: | 05/16/2022 | ||||||||
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| AuthorizedOfficialLastName: | MARK | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | ANDREW | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4066654103 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BIGHORN VALLEY HEALTH CENTER INCORPORATED | ||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/16/2022 | ||||||||
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.