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CAH271320-02 St. John's Lutheran Hospital DBA Cabinet Peaks Medical Center (Terminated)
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Main Details
Name
St. John's Lutheran Hospital DBA Cabinet Peaks Medical Center
Subdivision Name
PHYSICIANS AND SURGEONS GROUP
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH271320-02
Medicare Provider Number
271320
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
3/3/2011
Participating Start Date
4/1/2011
Participating Approval Date
3/9/2011
Last Recertification Date
8/11/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Cabinet Peaks Medical Center
Brigid Burke, CFO
(406) 283-7219
Primary Contact
Cabinet Peaks Medical Center
Amie Wells, Pharmacy Manager
(406) 283-7189
Addresses
Street Address
401 Louisiana Ave
LIBBY, MT 59923
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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9/21/11-Removed NPI # (was 1952312050)
09/21/2011
April 2025
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