Organization
PHILLIPS COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY LOU BROADBROOKS RN (RN, PHN)
(406) 654-2521
Entity
Organization
Contact information
Practice address
105 S. 2ND ST. E, MALTA, MT 59538-0241
(406) 654-2521
(406) 654-2523
Mailing address
PO BOX 241, 105 S. 2ND ST. E., MALTA, MT 59538-0241
(406) 654-2521
(406) 654-2523
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000003396
MEDICARE
MT
05
—
0000350370
—
MT
01
—
600000864
MEDICARE RAILROAD
MT
Enumeration date
03/08/2007
Last updated
05/06/2010
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