Provider Demographics
NPI:1144382813
Name:THE MONTANA HEALTHY WEIGHT MANAGEMENT AND WELLNESS CENTER, PC
Entity Type:Organization
Organization Name:THE MONTANA HEALTHY WEIGHT MANAGEMENT AND WELLNESS CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BASKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-542-3687
Mailing Address - Street 1:2835 FORT MISSOULA RD STE 303
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:406-542-3687
Mailing Address - Fax:406-327-4475
Practice Address - Street 1:2835 FORT MISSOULA RD STE 303
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:406-542-3687
Practice Address - Fax:406-327-4475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6260174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT83246Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER