1497743959 NPI NUMBER - SIDNEY HEALTH CENTER

Summary

Detailed Information

NPI Number 1497743959 is assigned to an organization registered under the healthcare provider name SIDNEY HEALTH CENTER .
The provider is doing business as CLINIC PHARMACY .

The provider is physically located at:

214 14TH AVE SW
SIDNEY, MT
ZIP 59270
Phone: (406) 488-6563
Fax: (406) 488-2238

The provider's authorized official is LYNN W. BEYERLE .
The authorized official title is DIRECTOR OF PHARMACY and has the following contact phone number (406) 488-2131 .

The enumeration date for this NPI number is 10/10/2005 and was last updated on 12/22/2009 .

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies				View Code
2	183500000X	Pharmacist		1008	MT	View Code
3	3336C0003X	Pharmacy	Community/Retail Pharmacy	1008	MT	View Code

Other (Legacy) Identifiers

The following legacy identifiers for this provider are available:

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	211237	MEDICAID	MT
2	0296740004	MEDICARE NSC

NPI Record

No.	Field Name	Field Value
1	NPI	1497743959
2	Entity Type Code	2
3	Employer Identification Number EIN
4	Provider Organization Name Legal Business Name	SIDNEY HEALTH CENTER
5	Provider Other Organization Name	CLINIC PHARMACY
6	Provider Other Organization Name Type Code	3
7	Provider First Line Business Practice Location Address	214 14TH AVE SW
8	Provider Business Practice Location Address City Name	SIDNEY
9	Provider Business Practice Location Address State Name	MT
10	Provider Business Practice Location Address Postal Code	59270
11	Provider Business Practice Location Address Country Code If outside U S	US
12	Provider Business Practice Location Address Telephone Number	4064886563
13	Provider Business Practice Location Address Fax Number	4064882238
14	Provider Enumeration Date	10/10/2005
15	Last Update Date	12/22/2009
16	Authorized Official Last Name	BEYERLE
17	Authorized Official First Name	LYNN
18	Authorized Official Middle Name	W.
19	Authorized Official Title or Position	DIRECTOR OF PHARMACY
20	Authorized Official Telephone Number	4064882131
21	Healthcare Provider Taxonomy Code 1	332B00000X
22	Healthcare Provider Primary Taxonomy Switch 1	N
23	Healthcare Provider Taxonomy Code 2	183500000X
24	Provider License Number 2	1008
25	Provider License Number State Code 2	MT
26	Healthcare Provider Primary Taxonomy Switch 2	N
27	Healthcare Provider Taxonomy Code 3	3336C0003X
28	Provider License Number 3	1008
29	Provider License Number State Code 3	MT
30	Healthcare Provider Primary Taxonomy Switch 3	Y
31	Other Provider Identifier 1	211237
32	Other Provider Identifier Type Code 1	05
33	Other Provider Identifier State 1	MT
34	Other Provider Identifier 2	0296740004
35	Other Provider Identifier Type Code 2	07
36	Is Organization Subpart	N
37	Authorized Official Name Prefix Text	DR.
38	Authorized Official Credential Text	PHARM.D., R.PH.
39	Healthcare Provider Taxonomy Group 2	193400000X MULTIPLE SINGLE SPECIALTY GROUP

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This page was last updated on: 5/14/2013
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