NPIMap

Organization Active NPI

Missoula Community Health Services, Inc

Doing business as Mineral Community Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Superior, MT
National Provider Identifier
1720136088
Registry record updated Apr 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
275051 Issued in MT
Legal business name
MISSOULA COMMUNITY HEALTH SERVICES, INC
Doing business as
Mineral Community Hospital
Practice address
1208 6TH Ave
Superior, MT 59872-9618
Phone
(406) 822-4841
Fax
(406) 822-4963
NPI assigned
Jan 5, 2007
Last updated
Apr 5, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2019

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

Authorized official

Name
Mr. John S McNeece
Title
Ceo
Phone
(406) 822-4841

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 275051 MT Primary

Addresses

Primary practice location

1208 6TH Ave
Superior, MT 59872-9618

Mailing address

PO Box 66
Superior, MT 59872-0066
Phone (406) 822-4841

Other identifiers 1

IdentifierTypeStateIssuer
310007MedicaidMT

Other names 1

  • Mineral Community Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071001000351 MT Part A Provider - Critical Access Hospital 6709790603 Receives reassigned benefits from 2 practitioners
Practice locations: Superior, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720136088. Details of each certification follow.

Hospital certification: CCN 27Z331

Legal name
MISSOULA COMMUNITY HEALTH SERVICES, INC
Doing business as
MINERAL COMMUNITY HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Jun 27, 1984 in MT
Enrollment address
1208 6TH Ave
Superior, MT 59872-9667

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

Other NPIs with the same Medicare PAC ID 3

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 4

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

NameRoleSinceShare
Kristy Mask Individual W-2 Managing EmployeeBusiness Office Supervisor Jan 21, 2019
Carol Billadeau Individual Corporate Director Sep 1, 2012
Leona Belle Crichton Individual Corporate Director Sep 1, 2014
Stacy Conrow-Ververis Individual Corporate OfficerDirector of Finance Jan 1, 2019
W-2 Managing Employee Jun 10, 2002

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554422400000",
    "number": "1720136088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 66",
            "city": "SUPERIOR",
            "state": "MT",
            "postal_code": "598720066",
            "telephone_number": "406-822-4841",
            "fax_number": "406-822-4963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1208 6TH AVE",
            "city": "SUPERIOR",
            "state": "MT",
            "postal_code": "598729618",
            "telephone_number": "406-822-4841",
            "fax_number": "406-822-4963"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSOULA COMMUNITY HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-05",
        "last_updated": "2019-04-05",
        "status": "A",
        "authorized_official_last_name": "MCNEECE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "406-822-4841",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MT",
            "license": "275051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "310007",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mineral Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mineral Community Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Superior, MT

Sources for this page

Verify at the official NPI Registry.