Provider Demographics
NPI:1730438904
Name:MINERAL REGIONAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:MINERAL REGIONAL HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLAYLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-822-5112
Mailing Address - Street 1:PO BOX 698
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:MT
Mailing Address - Zip Code:59872-0698
Mailing Address - Country:US
Mailing Address - Phone:406-822-5112
Mailing Address - Fax:406-822-4912
Practice Address - Street 1:306 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:ALBERTON
Practice Address - State:MT
Practice Address - Zip Code:59820-9499
Practice Address - Country:US
Practice Address - Phone:406-822-5112
Practice Address - Fax:406-822-4912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MINERAL REGIONAL HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service