Provider Demographics
NPI:1053499574
Name:PATSY VARGO MD PC
Entity Type:Organization
Organization Name:PATSY VARGO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-727-5778
Mailing Address - Street 1:3511 1ST AVE N
Mailing Address - Street 2:STE 1
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3527
Mailing Address - Country:US
Mailing Address - Phone:406-727-5778
Mailing Address - Fax:406-761-7117
Practice Address - Street 1:3511 1ST AVE N
Practice Address - Street 2:STE 1
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3527
Practice Address - Country:US
Practice Address - Phone:406-727-5778
Practice Address - Fax:406-761-7117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0066181Medicaid
X95746Medicare UPIN
83531Medicare ID - Type Unspecified