1083756787 NPI number — BLACKFEET OPPORTUNITIES, INC.

Table of content: (NPI 1083756787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083756787 NPI number — BLACKFEET OPPORTUNITIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLACKFEET OPPORTUNITIES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083756787
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNING
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59417-0247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-338-5364
Provider Business Mailing Address Fax Number:
406-338-2942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLACKFEET OPPORTUNITES INC
Provider Second Line Business Practice Location Address:
213 N PIEGAN ST
Provider Business Practice Location Address City Name:
BROWNING
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-338-5364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOMBERG
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
406-338-5364

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)