Provider Demographics
NPI:1013197912
Name:CENTER FOR ASBETOS RELATED DISEASE
Entity Type:Organization
Organization Name:CENTER FOR ASBETOS RELATED DISEASE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNT REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELMERDINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-293-9274
Mailing Address - Street 1:214 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2056
Mailing Address - Country:US
Mailing Address - Phone:406-293-9274
Mailing Address - Fax:406-293-9280
Practice Address - Street 1:214 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2056
Practice Address - Country:US
Practice Address - Phone:406-293-9274
Practice Address - Fax:406-293-9280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty