Provider Demographics
NPI:1306857917
Name:ROCKY MOUNTAIN EAR, NOSE & THROAT CENTER, PC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN EAR, NOSE & THROAT CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BROE, CPC, CPPM, OCS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-541-3806
Mailing Address - Street 1:700 WEST KENT
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801
Mailing Address - Country:US
Mailing Address - Phone:406-541-3277
Mailing Address - Fax:406-541-3950
Practice Address - Street 1:700 WEST KENT
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-7000
Practice Address - Country:US
Practice Address - Phone:406-541-3277
Practice Address - Fax:406-541-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic AllergyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5835900001Medicare NSC
MT81777Medicare ID - Type Unspecified