Provider Demographics
NPI:1124586607
Name:PANGEA HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:PANGEA HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-871-5814
Mailing Address - Street 1:4254 BORDEAUX BLVD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-9686
Mailing Address - Country:US
Mailing Address - Phone:406-871-5814
Mailing Address - Fax:406-214-6334
Practice Address - Street 1:4254 BORDEAUX BLVD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-9686
Practice Address - Country:US
Practice Address - Phone:406-871-5814
Practice Address - Fax:406-214-6334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0553189Medicaid