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
Certification Date: 2022-02-14
Details
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NPI | 1104909696 | ||||||||||||||||||||
Enumeration Date | 2006-10-20 | ||||||||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||||||||
Status | Active | ||||||||||||||||||||
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 | ||||||||||||||||||||
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