Provider Demographics
NPI:1174537179
Name:SIDNEY HEALTH CENTER
Entity type:Organization
Organization Name:SIDNEY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BEYERLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:406-742-5222
Mailing Address - Street 1:304 SOUTH ELLERY AVE.
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:MT
Mailing Address - Zip Code:59221
Mailing Address - Country:US
Mailing Address - Phone:406-742-5222
Mailing Address - Fax:406-742-5263
Practice Address - Street 1:304 SOUTH ELLERY AVE.
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:MT
Practice Address - Zip Code:59221
Practice Address - Country:US
Practice Address - Phone:406-742-5222
Practice Address - Fax:406-742-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1509040Medicaid
MT0296740003Medicare ID - Type Unspecified