Butte Silver Bow Primary Health Care Clinic Inc
Organization Active NPI Community/Retail Pharmacy · Sheridan, MT
NPI 1104909696 · NPPES record last updated Feb 14, 2022
Key facts
- NPI
- 1104909696
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PHA-PHR-LIC-1315 (MT)
- Legal business name
- BUTTE SILVER BOW PRIMARY HEALTH CARE CLINIC INC
- Practice address
- 317 Madison St
Sheridan, MT 59749-9636 - Phone
- (406) 842-7434
- Fax
- (406) 842-5733
- NPI assigned
- Oct 20, 2006
- Organization subpart
- No
Authorized official
- Name
- Shawna Marie Yates, DO
- Title
- Executive Director
- Phone
- (406) 496-6018
Corporate family (same tax ID) 3
Practitioners 1
National Provider Directory
- Tax ID family
- Butte Silver Bow Primar
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | PHA-PHR-LIC-1315 | MT | Yes |
| Compounding Pharmacy | 3336C0004X | PHA-PHR-LIC-1315 | MT | |
| Long Term Care Pharmacy | 3336L0003X |
Addresses
Primary practice location
317 Madison St
Sheridan, MT 59749-9636
Mailing address
PO Box 525
Sheridan, MT 59749-0525
Phone (406) 842-7434
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2052510 | Other | PK | |
| 1104909696 | Medicaid | MT |
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All providers in Sheridan, MT · Community/Retail Pharmacy in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.