Provider Demographics
NPI:1306187398
Name:MONTANA OCCUPATIONAL HEALTH
Entity Type:Organization
Organization Name:MONTANA OCCUPATIONAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PA-C
Authorized Official - Phone:406-556-1900
Mailing Address - Street 1:536 S COTTONWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-9515
Mailing Address - Country:US
Mailing Address - Phone:406-556-1900
Mailing Address - Fax:406-548-6265
Practice Address - Street 1:536 S COTTONWOOD RD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-9515
Practice Address - Country:US
Practice Address - Phone:406-556-1900
Practice Address - Fax:406-548-6265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-15
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT117261QX0100X
MT264261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1366504102Medicaid
MT437920Medicaid
MT1366504102Medicaid
MT011004083Medicare PIN