NPIMap

Organization Active NPI

Wolf Point Clinic Association Inc

Doing business as Listeruds Rural Health Clinic

  • Rural Health Clinic/Center
  • Wolf Point, MT
National Provider Identifier
1992722904
Registry record updated Jun 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
WOLF POINT CLINIC ASSOCIATION INC
Doing business as
Listeruds Rural Health Clinic
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
Last updated
Jun 11, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2018

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

Authorized official

Name
Margaret B Norgaard
Title
Ceo
Phone
(406) 653-6512

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MT Primary

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 names 1

  • Listeruds Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992722904. Details of each certification follow.

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
CorporationNon-profit
Incorporated
May 6, 1980 in MT
Enrollment address
301 Knapp St
Wolf Point, MT 59201-1826

National Provider Directory

National Provider Directory

Locations

100 Main St
Wolf Point, MT 59201

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
Shane Gibson Individual Corporate DirectorBoard Member Feb 23, 2011
Roger D Fisher Individual Corporate OfficerCoo Jul 2, 2017
W-2 Managing EmployeeAd;Coo Jul 2, 2017
Tiffany Smith Individual W-2 Managing EmployeeAdministrative Assistant Feb 5, 2024
Wolf Point Clinic Association Inc Organization, Wolf Point, MT Non-profit Operational/Managerial Control Jul 1, 1996
Debra J McGowan Individual Corporate DirectorBoard Member Jul 1, 2019
Richard Baland Individual Corporate OfficerCfo May 21, 2023
Victoria Matejovsky Individual Corporate DirectorBoard Member Jul 1, 2019
Dallas O'Connor Individual Corporate DirectorBoard Member Jul 1, 1996
Northeast Montana Health Services Inc Organization, Wolf Point, MT Corporation, Non-profit Operational/Managerial Control Jul 1, 1996
Steven Hackley Individual Corporate DirectorBoard Chairman Jul 1, 2020
Daniel Moudree Individual Corporate DirectorBoard Member Jul 1, 2019

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 35

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 35

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528675200000",
    "number": "1992722904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 KNAPP ST",
            "city": "WOLF POINT",
            "state": "MT",
            "postal_code": "592011826",
            "telephone_number": "406-653-2150",
            "fax_number": "406-653-6591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 KNAPP ST",
            "city": "WOLF POINT",
            "state": "MT",
            "postal_code": "592011826",
            "telephone_number": "406-653-2150",
            "fax_number": "406-653-6591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOLF POINT CLINIC ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2018-06-11",
        "deactivation_date": "2018-05-16",
        "reactivation_date": "2018-06-11",
        "status": "A",
        "authorized_official_last_name": "NORGAARD",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "406-653-6512"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Listeruds Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wolf Point, MT

Sources for this page

Verify at the official NPI Registry.