Provider Demographics
NPI:1417461732
Name:WESTERN MONTANA FOOT AND ANKLE PLLC
Entity Type:Organization
Organization Name:WESTERN MONTANA FOOT AND ANKLE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:406-543-5333
Mailing Address - Street 1:2825 STOCKYARD RD STE J1
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1548
Mailing Address - Country:US
Mailing Address - Phone:406-543-5333
Mailing Address - Fax:406-543-5621
Practice Address - Street 1:2825 STOCKYARD RD STE J1
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1548
Practice Address - Country:US
Practice Address - Phone:406-543-5333
Practice Address - Fax:406-543-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-22
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT174213ES0103X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty