Provider Demographics
NPI:1073770525
Name:ST PATRICK HOSP AND HEALTH SCI CTR
Entity Type:Organization
Organization Name:ST PATRICK HOSP AND HEALTH SCI CTR
Other - Org Name:ST PARTICK HOSPITAL AND HEALTH SCIENCES CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CARDIOVASCULAR SERVICE LINE ADMINIS
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-329-5615
Mailing Address - Street 1:500 W BROADWAY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4003
Mailing Address - Country:US
Mailing Address - Phone:406-329-5615
Mailing Address - Fax:406-329-5606
Practice Address - Street 1:357 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ST. IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-9720
Practice Address - Country:US
Practice Address - Phone:406-329-5615
Practice Address - Fax:406-329-5606
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST PATRICK HOSP AND HEALTH SCI CTR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-21
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty