Basic Information
| Provider Information | |||||||||
| NPI: | 1811016652 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST JOSEPH HOSPITAL CORPORATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WESTERN MONTANA MEDICAL CLINIC-POLSON | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1010 | ||||||||
| Address2: | |||||||||
| City: | POLSON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598601010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068838933 | ||||||||
| FaxNumber: | 4068838910 | ||||||||
| Practice Location | |||||||||
| Address1: | 6 13TH AVE E | ||||||||
| Address2: | |||||||||
| City: | POLSON | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598605315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068838933 | ||||||||
| FaxNumber: | 4068838254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 06/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | WEBBER | ||||||||
| AuthorizedOfficialFirstName: | HEIDI | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4068838913 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.