Provider Demographics
NPI:1326242934
Name:MONTANA LITHOTRIPSY,LLC
Entity Type:Organization
Organization Name:MONTANA LITHOTRIPSY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ERVIN
Authorized Official - Last Name:KUGLITSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-723-7000
Mailing Address - Street 1:630 W MERCURY ST
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1510
Mailing Address - Country:US
Mailing Address - Phone:406-723-7000
Mailing Address - Fax:406-723-7004
Practice Address - Street 1:630 W MERCURY ST
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1510
Practice Address - Country:US
Practice Address - Phone:406-723-7000
Practice Address - Fax:406-723-7004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier