Provider Demographics
NPI:1164616504
Name:PEDIATRIC CARDIOLOGY OF BILLINGS PC
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY OF BILLINGS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:WISE
Authorized Official - Last Name:WIGGINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:406-238-6190
Mailing Address - Street 1:1232 N 30TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-0139
Mailing Address - Country:US
Mailing Address - Phone:406-238-6190
Mailing Address - Fax:406-238-6199
Practice Address - Street 1:1232 N 30TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0139
Practice Address - Country:US
Practice Address - Phone:406-238-6190
Practice Address - Fax:406-238-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5109261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM01324560Medicaid
MT0100215Medicaid
SD7713690Medicaid
ND11586Medicaid
NM01324560Medicaid
SD7713690Medicaid