Roundup Memorial Hospital Association
Organization Active NPI Rural Health Clinic/Center · Roundup, MT
NPI 1902908262 · NPPES record last updated Jun 30, 2020
Key facts
- NPI
- 1902908262
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 10506 (MT)
- Legal business name
- ROUNDUP MEMORIAL HOSPITAL ASSOCIATION
- Practice address
- 1207 Second St W
Roundup, MT 59072-1835 - Phone
- (406) 323-3337
- Fax
- (406) 323-3002
- NPI assigned
- Sep 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Holly Wolff
- Title
- Chief Executive Officer
- Phone
- (406) 323-2301
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Related certifications (CCN) 1
Practitioners 53
-
Brynn Marie Bixby, MPAC
-
Sarah A Cruse, FNP-BC
-
Tyler Chase Faw, PA-C
-
Paul F Hunt, M.D.
-
Tyler J Gavinski, PA-C
-
Cameron J Grove, MD
-
William Scott Schroyer, PA-C
-
Katie Lynn Zupan, PA-C
-
Sterling T. Fenwick, PA-C
-
Douglas Bell, MD
-
Tammy Jean Chambers, FNP
-
Zoe Elaine Fugere, FNP-C
-
Heather I Gale, MD
-
Sean Timothy Jones, M.D.
-
Wendy Sue Killham, FNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 27D0873400 | Roundup Memorial Healthcare-Clinic | Certificate of waiver | Jul 22, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MT
Rural health clinic certification: CCN 273982
- Legal name
- ROUNDUP MEMORIAL HOSPITAL ASSOCIATION
- Doing business as
- ROUNDUP MEMORIAL HEALTHCARE CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 25, 1994
- Last certification
- Nov 17, 2025
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 31, 1964 in MT
- Enrollment address
- 1207 2ND St W
Roundup, MT 59072-1835 - Related CCNs
- 271346
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| John Pfister |
Corporate Director | Oct 1, 2009 | |
| Kenneth Mosdal |
Corporate Director | Dec 3, 1998 | |
| Marshall W White |
Corporate Director | Dec 12, 2010 | |
| Ricky a Schroeder |
Corporate Officer |
Oct 5, 2023 | |
| W-2 Managing Employee | Oct 5, 2023 | ||
| Mark S Rosebush |
Corporate Director | Jan 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040119000371 | MT | Part B Supplier - Clinic/Group Practice | 5395646707 |
Receives reassigned benefits from 49 practitioners 2 other NPIs on this enrollment Practice locations: Roundup, MT |
| O20060215000516 | MT | Part a Provider - Rural Health Clinic | 5395646707 | Practice locations: Roundup, MT |
National Provider Directory
Locations
1207 2nd St W
Roundup, MT 59072
Phone (406) 323-2301
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 10506 | MT | Yes |
| General Acute Care Hospital | 282N00000X | 10506 | MT |
Addresses
Primary practice location
1207 Second St W
Roundup, MT 59072-1835
Mailing address
1207 Second St W
Roundup, MT 59072-1835
Phone (406) 323-3337
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0720395 | Medicaid | MT |
Other names
- Roundup Memorial Healthcare - Clinic
Other providers in Roundup, MT
- Musselshell County
- Deborah Pascal
- Roundup Family Dentistry
- Roundup Memorial Hospital Association
- Roundup Memorial Hospital Association
- Isabelle Kathleen Schroyer
- William Scott Schroyer
- Shopko Stores Operating Co LLC
- Sylvia Rose Snider
- Brynn Stahl
All providers in Roundup, MT · Rural 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 Jun 30, 2020. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.