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Provider Information for 1104909696


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BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC INC

Organization Subpart: NO

NPI: 1104909696
Last Updated: 2022-02-14
Certification Date: 2022-02-14

Details

NameValue
NPI1104909696
Enumeration Date2006-10-20
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: SHAWNA MARIE YATES DO
Title: Executive Director
Phone: 4064966018
Mailing Address PO BOX 525
SHERIDAN, MT 59749-0525
United States

Phone: 406-842-7434 | Fax:406-842-5733
 
Primary Practice Address 317 MADISON ST
SHERIDAN, MT 59749-9636
United States

Phone: 406-842-7434 | Fax:406-842-5733
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDMT1104909696
Other (non-Medicare)2052510PK
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 333600000X - Pharmacy
No 3336C0004X - Pharmacy - Compounding PharmacyMTPHA-PHR-LIC-1315
No 3336L0003X - Pharmacy - Long Term Care Pharmacy
Yes 3336C0003X - Pharmacy - Community/Retail PharmacyMTPHA-PHR-LIC-1315