Provider Demographics
NPI:1114221983
Name:MA CRITICAL CARE SERVICES, PC
Entity Type:Organization
Organization Name:MA CRITICAL CARE SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BARB
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLETT BRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-728-8420
Mailing Address - Street 1:PO BOX 17527
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-7527
Mailing Address - Country:US
Mailing Address - Phone:406-728-8420
Mailing Address - Fax:406-541-8430
Practice Address - Street 1:2825 STOCKYARD RD STE I-200
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1548
Practice Address - Country:US
Practice Address - Phone:406-728-8420
Practice Address - Fax:406-541-8430
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSOULA ANESTHESIOLOGY, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty