Provider Demographics
NPI:1083879415
Name:EDWARD L PIERCE MD PC
Entity Type:Organization
Organization Name:EDWARD L PIERCE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-488-2231
Mailing Address - Street 1:214 14TH AVE SW
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270
Mailing Address - Country:US
Mailing Address - Phone:406-488-2231
Mailing Address - Fax:406-488-2520
Practice Address - Street 1:214 14TH AVE SW
Practice Address - Street 2:SUITE 112
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3521
Practice Address - Country:US
Practice Address - Phone:406-488-2231
Practice Address - Fax:406-488-2520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6141207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT64584Medicaid
MTD07971OtherUPIN
MTAP6927909OtherDEA