Provider Demographics
NPI:1376154039
Name:MONTANA SPINAL SOLUTIONS PLLC
Entity Type:Organization
Organization Name:MONTANA SPINAL SOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-533-9688
Mailing Address - Street 1:BILLINGS CLINIC, BOZEMAN
Mailing Address - Street 2:3905 WELLNESS WAY
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718
Mailing Address - Country:US
Mailing Address - Phone:406-533-9688
Mailing Address - Fax:469-898-1659
Practice Address - Street 1:BILLINGS CLINIC, BOZEMAN
Practice Address - Street 2:3905 WELLNESS WAY
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718
Practice Address - Country:US
Practice Address - Phone:406-533-9688
Practice Address - Fax:469-898-1659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT11747OtherMD LIC