NPIMap

Organization Active NPI

Lincoln County Community Health Center, Inc.

Doing business as Northwest Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Libby, MT
National Provider Identifier
1477574713
Registry record updated Jan 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LINCOLN COUNTY COMMUNITY HEALTH CENTER, INC.
Doing business as
Northwest Community Health Center
Practice address
320 East Second Street
Libby, MT 59923
Phone
(406) 283-6900
Fax
(406) 293-6622
NPI assigned
Jul 22, 2006
Last updated
Jan 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2023

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

Authorized official

Name
Maria Clemons, CPA
Title
Executive Director
Phone
(406) 283-6919

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

320 East Second Street
Libby, MT 59923

Mailing address

320 East Second Street
Libby, MT 59923
Phone (406) 283-6900

Other names 1

  • Northwest Community Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040205001090 MT Part B Supplier - Clinic/Group Practice 6507778537 Receives reassigned benefits from 16 practitioners
Practice locations: Troy, MT; Libby, MT
O20070319000658 MT Part A Provider - Federally Qualified Health Center (FQHC) 6507778537 Practice locations: Libby, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477574713. Details of each certification follow.

Federally qualified health center certification: CCN 271814

Legal name
LINCOLN COUNTY COMMUNITY HEALTH CENTER INC
Doing business as
NORTHWEST COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 10, 2002
Last certification
Apr 10, 2002
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 18, 2001 in MT
Enrollment address
320 E 2ND St
Libby, MT 59923-2010

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Maria Anne Clemons Individual Corporate Officer Aug 1, 2004
W-2 Managing Employee Feb 12, 2007
Deborah Guenther Individual Corporate Director Sep 10, 2019
Shelley May Individual Corporate Director May 20, 2020
Terrie Noser Individual Corporate Director Sep 17, 2002
John Damon Individual Corporate Director Oct 30, 2018
Theresa Herman Individual Corporate Director May 20, 2022
Kate Huntsberger Individual Corporate Director May 13, 2022
Ray Reisman Individual Corporate Director Sep 17, 2002
Keith McBride Individual Corporate Director May 20, 2022
Diane Rewerts Individual Corporate Director Jan 1, 2015
Leslie Crooks Individual Corporate Director Aug 21, 2007

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674777600000",
    "number": "1477574713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 EAST SECOND STREET",
            "city": "LIBBY",
            "state": "MT",
            "postal_code": "59923",
            "telephone_number": "406-283-6900",
            "fax_number": "406-293-6622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 EAST SECOND STREET",
            "city": "LIBBY",
            "state": "MT",
            "postal_code": "59923",
            "telephone_number": "406-283-6900",
            "fax_number": "406-293-6622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN COUNTY COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-27",
        "status": "A",
        "authorized_official_last_name": "CLEMONS",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "406-283-6919",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northwest Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Libby, MT

Sources for this page

Verify at the official NPI Registry.