Provider Demographics
NPI:1437557865
Name:MTRHEUMATOLOGY, PC
Entity Type:Organization
Organization Name:MTRHEUMATOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCNUTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-422-4401
Mailing Address - Street 1:121 N LAST CHANCE GULCH
Mailing Address - Street 2:STE H
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4159
Mailing Address - Country:US
Mailing Address - Phone:406-422-4401
Mailing Address - Fax:406-422-4402
Practice Address - Street 1:121 N LAST CHANCE GULCH
Practice Address - Street 2:STE H
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4159
Practice Address - Country:US
Practice Address - Phone:406-422-4401
Practice Address - Fax:406-422-4402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11855261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center