Provider Demographics
NPI:1043257983
Name:ST. VINCENT HEALTHCARE
Entity type:Organization
Organization Name:ST. VINCENT HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOVELESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-237-3071
Mailing Address - Street 1:2900 12TH AVENUE NORTH
Mailing Address - Street 2:SUITE 160W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7508
Mailing Address - Country:US
Mailing Address - Phone:406-237-8500
Mailing Address - Fax:406-237-8501
Practice Address - Street 1:2900 12TH AVENUE NORTH
Practice Address - Street 2:SUITE 160W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7508
Practice Address - Country:US
Practice Address - Phone:406-237-8500
Practice Address - Fax:406-237-8501
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. VINCENT HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-31
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT13258261Q00000X, 261QP2300X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000080511Medicare ID - Type Unspecified