Provider Demographics
NPI:1154460434
Name:UNIVERSITY OF MONTANA
Entity Type:Organization
Organization Name:UNIVERSITY OF MONTANA
Other - Org Name:RURAL INSTITUTE-MONTECH
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:406-243-4779
Mailing Address - Street 1:700 SW HIGGINS AVE.,
Mailing Address - Street 2:SUITE 250
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-3602
Mailing Address - Country:US
Mailing Address - Phone:406-243-5769
Mailing Address - Fax:406-243-4730
Practice Address - Street 1:700 SW HIGGINS AVE.,
Practice Address - Street 2:SUITE 250
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-3602
Practice Address - Country:US
Practice Address - Phone:406-243-5769
Practice Address - Fax:406-243-4730
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF MONTANA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-05
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0005602095Medicaid
MT600627Medicaid
MT600627Medicaid
MT0005602095Medicaid