Provider Demographics
NPI:1164519377
Name:CENTRAL MONTANA LABORATORY, LLC
Entity Type:Organization
Organization Name:CENTRAL MONTANA LABORATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHRISTIAENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-454-1211
Mailing Address - Street 1:1411 9TH ST S
Mailing Address - Street 2:SUITE B101
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4503
Mailing Address - Country:US
Mailing Address - Phone:406-454-1211
Mailing Address - Fax:406-454-9916
Practice Address - Street 1:1411 9TH ST S
Practice Address - Street 2:SUITE B101
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4503
Practice Address - Country:US
Practice Address - Phone:406-454-1211
Practice Address - Fax:406-454-9916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1164519377OtherNPI