Provider Demographics
NPI:1225385966
Name:MEDICAL ASSOCIATES OF MONTANA LLC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF MONTANA LLC
Other - Org Name:MEDICAL ASSOCIATES OF MONTANA
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-625-7887
Mailing Address - Street 1:601 MOUNTAIN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-8433
Mailing Address - Country:US
Mailing Address - Phone:908-625-7887
Mailing Address - Fax:
Practice Address - Street 1:601 MOUNTAIN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-8433
Practice Address - Country:US
Practice Address - Phone:908-625-7887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 224P00000X
NJ40QA01375700225100000X
NJ25MA08851700291U00000X
NJ26NO07865600363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1528378072OtherNPI
NJ1528378072OtherNPI
NJ802499Medicare UPIN