Provider Demographics
NPI:1417366576
Name:DR. RHONDA EICKHOLT MHAPRN P.C.
Entity Type:Organization
Organization Name:DR. RHONDA EICKHOLT MHAPRN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:EICKHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:MHAPRN
Authorized Official - Phone:406-777-6958
Mailing Address - Street 1:3972 US HIGHWAY 93 N
Mailing Address - Street 2:SUITE C
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-6494
Mailing Address - Country:US
Mailing Address - Phone:406-777-6958
Mailing Address - Fax:406-777-5869
Practice Address - Street 1:3972 US HIGHWAY 93 N
Practice Address - Street 2:SUITE C
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-6494
Practice Address - Country:US
Practice Address - Phone:406-777-6958
Practice Address - Fax:406-777-5869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-03
Last Update Date:2014-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT37331261Q00000X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1043599939Medicaid
MTM011002018Medicare UPIN