Provider Demographics
NPI:1114098837
Name:BADLANDS MEDICAL INC
Entity Type:Organization
Organization Name:BADLANDS MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-557-2819
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:JORDAN
Mailing Address - State:MT
Mailing Address - Zip Code:59337-0443
Mailing Address - Country:US
Mailing Address - Phone:406-557-2819
Mailing Address - Fax:
Practice Address - Street 1:332 LEAVITT AVE
Practice Address - Street 2:
Practice Address - City:JORDAN
Practice Address - State:MT
Practice Address - Zip Code:59337
Practice Address - Country:US
Practice Address - Phone:406-557-2819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty