NPIMap

Organization Active NPI

Missoula Community Health Services, Inc

Doing business as Mineral Community Hospital Clinic

  • Multi-Specialty Clinic/Center
  • Superior, MT
National Provider Identifier
1073080461
Registry record updated Oct 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
MISSOULA COMMUNITY HEALTH SERVICES, INC
Doing business as
Mineral Community Hospital Clinic
Practice address
1208 6TH Ave
Superior, MT 59872-9667
Phone
(406) 822-4841
NPI assigned
Oct 24, 2018
Last updated
Oct 12, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stacy Conrow-Ververis
Title
Cfo
Phone
(406) 822-4841

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

1208 6TH Ave
Superior, MT 59872-9667

Mailing address

PO Box 66
Superior, MT 59872-0066
Phone (406) 822-4841

Other names 1

  • Mineral Community Hospital Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031114000597 MT Part B Supplier - Clinic/Group Practice 6709790603 Receives reassigned benefits from 20 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Superior, MT

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1540339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665532800000",
    "number": "1073080461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66",
            "city": "SUPERIOR",
            "state": "MT",
            "postal_code": "598720066",
            "telephone_number": "406-822-4841",
            "fax_number": "406-822-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 6TH AVE",
            "city": "SUPERIOR",
            "state": "MT",
            "postal_code": "598729667",
            "telephone_number": "406-822-4841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOULA COMMUNITY HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-24",
        "last_updated": "2022-10-12",
        "certification_date": "2022-10-12",
        "status": "A",
        "authorized_official_last_name": "CONROW-VERVERIS",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "406-822-4841"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mineral Community Hospital Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mineral Community Hospital Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Superior, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.