Provider Demographics
NPI:1114068517
Name:MONTANA NEUROSURGERY CENTER PLLC
Entity Type:Organization
Organization Name:MONTANA NEUROSURGERY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:AA
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-327-4290
Mailing Address - Street 1:2835 FORT MISSOULA RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7424
Mailing Address - Country:US
Mailing Address - Phone:406-327-4290
Mailing Address - Fax:406-327-4291
Practice Address - Street 1:2835 FORT MISSOULA RD STE 202
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7424
Practice Address - Country:US
Practice Address - Phone:406-327-4290
Practice Address - Fax:406-327-4291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8014207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5408500001Medicare NSC