Provider Demographics
NPI:1730343492
Name:NORTHEAST MONTANA HEALTH SERVICES INC
Entity type:Organization
Organization Name:NORTHEAST MONTANA HEALTH SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BALAND
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:512-484-4850
Mailing Address - Street 1:1115 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-1829
Mailing Address - Country:US
Mailing Address - Phone:406-653-6500
Mailing Address - Fax:406-653-6592
Practice Address - Street 1:1115 4TH AVE N
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-1829
Practice Address - Country:US
Practice Address - Phone:406-653-6572
Practice Address - Fax:406-653-6561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2023-11-05
Deactivation Date:2018-05-16
Deactivation Code:
Reactivation Date:2018-05-31
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
MT12653336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1730343492Medicaid
2052670OtherPK