Provider Demographics
NPI:1134297179
Name:INTERMOUNTAIN PLANNED PARENTHOOD INC
Entity Type:Organization
Organization Name:INTERMOUNTAIN PLANNED PARENTHOOD INC
Other - Org Name:PLANNED PARENTHOOD OF MONTANA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAE
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:406-869-5009
Mailing Address - Street 1:1116 GRAND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-4282
Mailing Address - Country:US
Mailing Address - Phone:406-248-3637
Mailing Address - Fax:406-254-9330
Practice Address - Street 1:1844 BROADWATER AVE SUITE 4
Practice Address - Street 2:(PPMT BILLINGS WEST)
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102
Practice Address - Country:US
Practice Address - Phone:406-656-9980
Practice Address - Fax:406-656-9928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT332900000XOtherNON-PHARMACY DISPENSING
MT8806889Medicaid
MT8806889Medicaid