Provider Demographics
NPI:1902962103
Name:ANACONDA DEER LODGE COUNTY
Entity Type:Organization
Organization Name:ANACONDA DEER LODGE COUNTY
Other - Org Name:ANACONDA-DEER LODGE COUNTY PUBLIC HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASIRICO
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MPH
Authorized Official - Phone:406-563-7863
Mailing Address - Street 1:P.O. BOX 970
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-0970
Mailing Address - Country:US
Mailing Address - Phone:406-563-7863
Mailing Address - Fax:406-563-2387
Practice Address - Street 1:115 W COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2246
Practice Address - Country:US
Practice Address - Phone:406-563-7863
Practice Address - Fax:406-563-2387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANACONDA DEER LODGE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-29
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3505931Medicaid
MT290472OtherFOLLOWME TARGETED CASE MA
MT312078OtherBLUE CROSS BLUE SHEILD
MT290329OtherMIAMI TARGETED CASE MANAG
MT000003630Medicare ID - Type Unspecified