Provider Demographics
NPI:1447260195
Name:GLENDIVE MEDICAL CENTER, INC
Entity type:Organization
Organization Name:GLENDIVE MEDICAL CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-345-8924
Mailing Address - Street 1:202 PROSPECT DR
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-1943
Mailing Address - Country:US
Mailing Address - Phone:406-345-3306
Mailing Address - Fax:406-345-3358
Practice Address - Street 1:2000 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-3700
Practice Address - Country:US
Practice Address - Phone:406-345-8855
Practice Address - Fax:406-345-8121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0348530Medicaid
MT000082OtherBLUE CROSS OT
MT275144Medicare ID - Type UnspecifiedEMVH OT