Provider Demographics
NPI:1760836167
Name:YELLOWSTONE SURGERY CENTER LLC
Entity type:Organization
Organization Name:YELLOWSTONE SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-237-5900
Mailing Address - Street 1:PO BOX 31715
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-1715
Mailing Address - Country:US
Mailing Address - Phone:406-237-5900
Mailing Address - Fax:406-237-5910
Practice Address - Street 1:1739 SPRING CREEK DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6747
Practice Address - Country:US
Practice Address - Phone:406-237-5900
Practice Address - Fax:406-237-5910
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YELLOWSTONE SURGERY CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical