NPIMap

Organization Active NPI

St. Lukes Community Hospital

Doing business as St. Luke Community Clinic Ronan

  • Rural Health Clinic/Center
  • Ronan, MT
National Provider Identifier
1093876344
Registry record updated Sep 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ST. LUKES COMMUNITY HOSPITAL
Doing business as
St. Luke Community Clinic Ronan
Practice address
126 6TH Ave SW
Ronan, MT 59864-2600
Phone
(406) 676-3600
Fax
(406) 676-3738
NPI assigned
Dec 12, 2006
Last updated
Sep 28, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2018

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

Authorized official

Name
Ms. Liane Clairmont
Title
Executive Assistant
Phone
(406) 676-4441

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Orthopaedic Surgery Physician 207X00000X
Psychiatry Physician 2084P0800X
Surgery Physician 208600000X

Addresses

Primary practice location

126 6TH Ave SW
Ronan, MT 59864-2600

Mailing address

107 6TH Ave SW
Ronan, MT 59864-2634
Phone (406) 676-4441

Other names 1

  • St. Luke Community Clinic Ronan Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031121000276 MT Part B Supplier - Clinic/Group Practice 5496659567 Receives reassigned benefits from 88 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Polson, MT; Ronan, MT
O20170411001321 MT Part A Provider - Rural Health Clinic 5496659567 Practice locations: Ronan, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093876344. Details of each certification follow.

Rural health clinic certification: CCN 273431

Legal name
ST LUKES COMMUNITY HOSPITAL
Doing business as
ST. LUKE COMMUNITY CLINIC RONAN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 22, 2018
Last certification
Jul 2, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1953 in MT
Enrollment address
126 6TH Ave SW
Ste a
Ronan, MT 59864-2639
Related CCNs
271325

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
27D0875932St Luke Community Clinics Ronan126 6TH Avenue SW, Ronan, MT 59864Provider-performed microscopyDec 20, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Martin M Olsson Individual Corporate DirectorBoard Member Jan 1, 1989
Holly Castor Individual Corporate DirectorBoard Member Jan 1, 1992
Steven J Todd Individual Corporate DirectorBoard Member Sep 1, 2013
W-2 Managing EmployeeCeo Sep 1, 2013
Edred T Vizcarra Individual Corporate DirectorBoard Member Jan 1, 2016
August T Pavlock Individual Corporate DirectorBoard Member Jul 1, 2012
Philip Grainey Individual Corporate DirectorBoard Member Jan 1, 1985
Jennifer McGinnis Individual Corporate DirectorBoard Member Jan 1, 2011

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538092800000",
    "number": "1093876344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 6TH AVE SW",
            "city": "RONAN",
            "state": "MT",
            "postal_code": "598642634",
            "telephone_number": "406-676-4441",
            "fax_number": "406-676-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 6TH AVE SW",
            "city": "RONAN",
            "state": "MT",
            "postal_code": "598642600",
            "telephone_number": "406-676-3600",
            "fax_number": "406-676-3738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LUKES COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2018-09-28",
        "status": "A",
        "authorized_official_last_name": "CLAIRMONT",
        "authorized_official_first_name": "LIANE",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "406-676-4441",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Luke Community Clinic Ronan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Luke Community Clinic Ronan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ronan, MT

Sources for this page

Verify at the official NPI Registry.