Organization Name: | PONDERA MEDICAL CENTER RURAL HEALTH CLINIC |
NPI Number: | 1790869535 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CARL JIM CHRISTENSEN (CEO) |
Mailing Address: | 805 Sunset Blvd. Conrad |
State: | MT US |
Postal Code: | 594250758 |
Phone Number: | 4062713211 |
Fax Number: | 4062713917 |
NPI Enumeration Date: | 10/25/2006 |
NPI Last Update Date: | 09/18/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QR1300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Rural Health |
Taxonomy Definition: |