Organization Name: | CUSTER COUNTY COMMUNITY HEALTH |
NPI Number: | 1285611129 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHARON W WILCOX (CEO) |
Mailing Address: | 210 S Winchester Ave 2nd Floor Va Ste#136 Miles City |
State: | MT US |
Postal Code: | 593014742 |
Phone Number: | 4062348793 |
Fax Number: | 4062348796 |
NPI Enumeration Date: | 12/30/2005 |
NPI Last Update Date: | 05/02/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QF0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
Taxonomy Definition: |