Basic Information
| Provider Information | |||||||||
| NPI: | 1609954759 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIG SANDY MEDICAL CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 530 | ||||||||
| Address2: | |||||||||
| City: | BIG SANDY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 595200530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063782189 | ||||||||
| FaxNumber: | 4063782180 | ||||||||
| Practice Location | |||||||||
| Address1: | 166 MONTANA AVE EAST | ||||||||
| Address2: | |||||||||
| City: | BIG SANDY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 595200530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063782189 | ||||||||
| FaxNumber: | 4063782180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BOLD | ||||||||
| AuthorizedOfficialFirstName: | HARRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4063782189 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | MT | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
ID Information
| ID | Type | State | Issuer | Description | 009901 | 01 | MT | BCBS HCFA | OTHER | 0720052 | 05 | MT | MEDICAID | 064332 | 01 | MT | BCBS UB | OTHER |