Wolf Point Clinic Association Inc
Organization Active NPI Rural Health Clinic/Center · Wolf Point, MT
NPI 1992722904 · NPPES record last updated Jun 11, 2018
Key facts
- NPI
- 1992722904
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- WOLF POINT CLINIC ASSOCIATION INC
- Practice address
- 301 Knapp St
Wolf Point, MT 59201-1826 - Phone
- (406) 653-2150
- Fax
- (406) 653-6591
- NPI assigned
- Jul 16, 2006
- Reactivated
- Jun 11, 2018
- Organization subpart
- No
Authorized official
- Name
- Margaret B Norgaard
- Title
- Ceo
- Phone
- (406) 653-6512
Owners & managing parties with NPI records 2
Facilities with the same owner 1
Practitioners 35
-
David P Brown, CRNA
-
Abigaile Julio Higgins, FNP-C
-
Thomas Eugene Schultz, CRNA
-
Jill Ann Ibrahim, APN
-
Moshe M. Usadi, MD
-
Danette A McIntyre, FNP
-
Benjamin J Miller, ARNP
-
Mark W Zilkoski, MD
-
Robert B Bell, PA
-
Deanna Lynn Diulio, WHNP, CNM
-
Eric T Grant, PA-C
-
Joseph Randall Shollenbarger, MSN, RN, FNP-C
-
Frances Lynn Cook, ARNP-C
-
Kaitlyn Haynie, OTR/L
-
Judith A Lauridsen, CNP
-
Bethany Mae Legare, DPT
-
Jacob Wesley Armstrong, ARNP
-
Tammy Lynn Ballant, ARNP
-
Mike Douglas Berry, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MT
Rural health clinic certification: CCN 273992
- Legal name
- WOLF POINT CLINIC ASSOCIATION INC
- Doing business as
- LISTERUDS RURAL HEALTH CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 17, 1999
- Last certification
- Apr 29, 2025
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 6, 1980 in MT
- Enrollment address
- 301 Knapp St
Wolf Point, MT 59201-1826
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Shane Gibson |
Corporate Director |
Feb 23, 2011 | |
| Roger D Fisher |
Corporate Officer |
Jul 2, 2017 | |
| W-2 Managing Employee |
Jul 2, 2017 | ||
| Tiffany Smith |
W-2 Managing Employee |
Feb 5, 2024 | |
| Wolf Point Clinic Association Inc |
Operational/Managerial Control | Jul 1, 1996 | |
| Debra J McGowan |
Corporate Director |
Jul 1, 2019 | |
| Richard Baland |
Corporate Officer |
May 21, 2023 | |
| Victoria Matejovsky |
Corporate Director |
Jul 1, 2019 | |
| Dallas O'Connor |
Corporate Director |
Jul 1, 1996 | |
| Northeast Montana Health Services Inc |
Operational/Managerial Control | Jul 1, 1996 | |
| Steven Hackley |
Corporate Director |
Jul 1, 2020 | |
| Daniel Moudree |
Corporate Director |
Jul 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040817001372 | MT | Part B Supplier - Clinic/Group Practice | 3678546660 |
Receives reassigned benefits from 30 practitioners Practice locations: Wolf Point, MT |
| O20060322000665 | MT | Part a Provider - Rural Health Clinic | 3678546660 | Practice locations: Wolf Point, MT |
National Provider Directory
Locations
3600 Minnesota Dr
Ste 800
Minneapolis, MN 55435
Phone (612) 595-1100
100 Main St
Wolf Point, MT 59201
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | MT | Yes |
Addresses
Primary practice location
301 Knapp St
Wolf Point, MT 59201-1826
Mailing address
301 Knapp St
Wolf Point, MT 59201-1826
Phone (406) 653-2150
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0720154 | Medicaid | MT |
Other names
- Listeruds Rural Health Clinic
Other providers in Wolf Point, MT
- Debra Lauree Tubbs
- Michael R Uphues
- US Health Dept of Health & Human Services
- Natalie Jean Van Houten
- Joy Hansen White
- Wolf Point Health Center Pharmacy
- Wolf Point School District
- Kathy Jolene Wulf
- Mark W Zilkoski
- Mark Zygmond
All providers in Wolf Point, 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 11, 2018. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.