Provider Demographics
NPI:1861933764
Name:SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC
Entity type:Organization
Organization Name:SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC, AO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-237-8115
Mailing Address - Street 1:PO BOX 912960
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80291-2690
Mailing Address - Country:US
Mailing Address - Phone:406-237-8117
Mailing Address - Fax:406-237-8144
Practice Address - Street 1:1233 N 30TH ST
Practice Address - Street 2:STE W103
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0127
Practice Address - Country:US
Practice Address - Phone:406-237-8117
Practice Address - Fax:406-237-8139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
MTPHA-PHR-LIC-5103336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2176195OtherPK