- Enrollment id
- O20051229000782
- Enrollment state
- MT
- Provider type code
- 00-08
- Provider type text
- PART A PROVIDER - HOSPICE
- Npi
- 1760550354
- Multiple npi flag
- N
- Ccn
- 271521
- Associate id
- 1951375849
- Organization name
- MEMORIAL HOSPITAL ASSOCIATION
- Doing business as name
- BEARTOOTH BILLINGS CLINIC
- Incorporation date
- 2000-03-17
- Incorporation state
- MT
- Organization type structure
- CORPORATION
- Proprietary nonprofit
- N
- Address line 1
- 2525 N BROADWAY AVE
- City
- RED LODGE
- State
- MT
- Zip code
- 590689222