Pondera Medical Center Dutton Clinic
Organization Active NPI Community Health Clinic/Center · Dutton, MT
NPI 1508944505 · NPPES record last updated Nov 14, 2008
Key facts
- NPI
- 1508944505
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- Legal business name
- PONDERA MEDICAL CENTER DUTTON CLINIC
- Practice address
- 17 Main St West
Dutton, MT 59433 - Phone
- (406) 271-2202
- Fax
- (406) 271-3917
- NPI assigned
- Nov 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Mark Jones
- Title
- Coo
- Phone
- (406) 271-3211
Other NPIs on the same Medicare enrollment 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040304001137 | MT | Part B Supplier - Clinic/Group Practice | 8921917501 |
Receives reassigned benefits from 75 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Conrad, MT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | Yes |
Addresses
Primary practice location
17 Main St West
Dutton, MT 59433
Mailing address
805 Sunset Blvd
Conrad, MT 59425-0758
Phone (406) 271-2202
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00066442 | Other | MT | BCBS |
| 0036582 | Medicaid | MT |
Other names
- Pondera Medical Center
Other providers in Dutton, MT
All providers in Dutton, MT · Community Health Clinic/Center in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.