Provider Demographics
NPI:1093759748
Name:MONTANA FOOT CLINIC PC
Entity Type:Organization
Organization Name:MONTANA FOOT CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATHIAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:FETTIG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:406-245-0888
Mailing Address - Street 1:3419 CENTRAL AVE
Mailing Address - Street 2:STE B
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-6647
Mailing Address - Country:US
Mailing Address - Phone:406-245-0888
Mailing Address - Fax:406-245-1322
Practice Address - Street 1:3419 CENTRAL AVE
Practice Address - Street 2:STE B
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-6647
Practice Address - Country:US
Practice Address - Phone:406-245-0888
Practice Address - Fax:406-245-1322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT94500OtherBLUE CROSS AND BLUE SHIEL
MTDA5411OtherRAILROAD MEDICARE
MT0390762Medicaid
MTDA5411OtherRAILROAD MEDICARE
MT000083474Medicare ID - Type Unspecified