Basic Information
Provider Information
NPI: 1568008464
EntityType: 2
ReplacementNPI:  
OrganizationName: BARRETT HOSPITAL DEVELOPMENT CORPORATION
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: BARRETT HOSPITAL & HEALTHCARE
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 MT HIGHWAY 91 S
Address2:  
City: DILLON
State: MT
PostalCode: 597257379
CountryCode: US
TelephoneNumber: 4066831188
FaxNumber: 4066833206
Practice Location
Address1: 401 S ALABAMA ST STE 10
Address2:  
City: BUTTE
State: MT
PostalCode: 597012358
CountryCode: US
TelephoneNumber: 4066831188
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/26/2019
LastUpdateDate: 07/13/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: GIEM
AuthorizedOfficialFirstName: TINA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 4066833003
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/13/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261Q00000X  Y Ambulatory Health Care FacilitiesClinic/Center 

ID Information
IDTypeStateIssuerDescription
709374905MT MEDICAID


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