Organization
LAKE COUNTY
Active
Other names
Lake County Health Department
Organization subpart
No
Provider details
NPI number
Authorized official
EMILY COLOMEDA RN (HEALTH SERVICES DIRECTOR)
(406) 883-7288
Entity
Organization
Contact information
Practice address
802 MAIN ST, SUITE A, POLSON, MT 59860-3201
(406) 883-7288
(406) 883-7290
Mailing address
106 4TH AVE E, POLSON, MT 59860-2133
(406) 883-7288
(406) 883-7290
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
MT
261QF0050X
Non-Surgical Family Planning Clinic/Center
—
MT
261QP0905X
State or Local Public Health Clinic/Center
Primary
—
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31308
BLUE CROSS BLUE SHIELD
MT
05
—
3502109
—
MT
Enumeration date
09/29/2006
Last updated
01/19/2010
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