Provider Demographics
NPI:1427201680
Name:PIONEER MOUNTAIN NURSING SERVICE PLLC
Entity Type:Organization
Organization Name:PIONEER MOUNTAIN NURSING SERVICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LURA
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:BC APRN
Authorized Official - Phone:406-925-3794
Mailing Address - Street 1:PO BOX 846
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59624-0846
Mailing Address - Country:US
Mailing Address - Phone:406-925-3794
Mailing Address - Fax:406-422-5804
Practice Address - Street 1:900 N MONTANA AVE STE B6
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3845
Practice Address - Country:US
Practice Address - Phone:406-925-3794
Practice Address - Fax:406-422-5804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8413163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT85450Medicare UPIN
MT011002224Medicare PIN