NPIMap

Organization Active NPI

Credena Health LLC

Doing business as Credena Health Pharmacy St Joseph

  • Community/Retail Pharmacy
  • Polson, MT
National Provider Identifier
1073687919
Registry record updated Dec 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
CREDENA HEALTH LLC
Doing business as
Credena Health Pharmacy St Joseph
Practice address
6 13TH Ave E
Polson, MT 59860-5315
Phone
(406) 883-8444
Fax
(406) 883-8255
NPI assigned
Nov 20, 2006
Last updated
Dec 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2023

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

Authorized official

Name
Mike Skafi
Title
Avp/Secretary
Phone
(575) 650-3396

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

6 13TH Ave E
Polson, MT 59860-5315

Mailing address

PO Box 2704
Portland, OR 97208-2704

Other identifiers 1

IdentifierTypeStateIssuer
2702048OtherMTNAPB NUMBER

Other names 1

  • Credena Health Pharmacy St Joseph Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191104002892 MT Part B Supplier - Mass Immunization (Roster Biller Only) 7810207206 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Polson, MT; Missoula, MT
O20191114000809 MT Part B Supplier - Pharmacy 7810207206 3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Missoula, MT; Polson, MT

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
St Joseph Hospital Corporation7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701907200000",
    "number": "1073687919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2704",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972082704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 13TH AVE E",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598605315",
            "telephone_number": "406-883-8444",
            "fax_number": "406-883-8255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREDENA HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-20",
        "last_updated": "2023-12-07",
        "certification_date": "2023-12-01",
        "status": "A",
        "authorized_official_last_name": "SKAFI",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "AVP/SECRETARY",
        "authorized_official_telephone_number": "575-650-3396"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NAPB NUMBER",
            "identifier": "2702048",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Credena Health Pharmacy St Joseph",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Credena Health Pharmacy St Joseph",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Polson, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; 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.