Provider Demographics
NPI:1487741005
Name:BIGHORN VALLEY HEALTH CENTER, INCORPORATED
Entity type:Organization
Organization Name:BIGHORN VALLEY HEALTH CENTER, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-665-4103
Mailing Address - Street 1:112 W LEWIS ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-3011
Mailing Address - Country:US
Mailing Address - Phone:406-823-6314
Mailing Address - Fax:406-222-5798
Practice Address - Street 1:112 W LEWIS ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3011
Practice Address - Country:US
Practice Address - Phone:406-823-6304
Practice Address - Fax:406-222-5798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7015086Medicaid