Provider Demographics
NPI:1275022543
Name:HELENA FOOT SPECIALISTS LLC
Entity Type:Organization
Organization Name:HELENA FOOT SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:QUEBEDEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:406-442-8111
Mailing Address - Street 1:2646 WINNE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4915
Mailing Address - Country:US
Mailing Address - Phone:406-442-8111
Mailing Address - Fax:406-442-4902
Practice Address - Street 1:2646 WINNE AVE STE 1
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4915
Practice Address - Country:US
Practice Address - Phone:406-442-8111
Practice Address - Fax:406-442-4902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-02
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-POD-LIC-111213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT390702Medicaid