Provider Demographics
NPI:1265605398
Name:EASTERN MONTANA HEALTH COMPANY
Entity type:Organization
Organization Name:EASTERN MONTANA HEALTH COMPANY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN'S ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BIESHEUVEL
Authorized Official - Suffix:
Authorized Official - Credentials:PA/C
Authorized Official - Phone:406-436-2651
Mailing Address - Street 1:507 NORTH LINCOLN AVE
Mailing Address - Street 2:BOX 489
Mailing Address - City:BROADUS
Mailing Address - State:MT
Mailing Address - Zip Code:59317-0489
Mailing Address - Country:US
Mailing Address - Phone:406-436-2651
Mailing Address - Fax:406-436-2652
Practice Address - Street 1:507 NORTH LINCOLN AVE
Practice Address - Street 2:BOX 489
Practice Address - City:BROADUS
Practice Address - State:MT
Practice Address - Zip Code:59317-0489
Practice Address - Country:US
Practice Address - Phone:406-436-2651
Practice Address - Fax:406-436-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT17261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT90943OtherBCBS
MT0720070Medicaid
MT0720070Medicaid