Provider Demographics
NPI:1467635920
Name:STUART N. KIERAN, M.D., PLLC
Entity Type:Organization
Organization Name:STUART N. KIERAN, M.D., PLLC
Other - Org Name:BITTERROORT NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:KIERAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-375-9310
Mailing Address - Street 1:PO BOX 2218
Mailing Address - Street 2:1019 W MAIN
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-4218
Mailing Address - Country:US
Mailing Address - Phone:406-375-9310
Mailing Address - Fax:406-375-9305
Practice Address - Street 1:1019 W MAIN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-4218
Practice Address - Country:US
Practice Address - Phone:406-375-9310
Practice Address - Fax:406-375-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT102722084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0064740Medicaid
MT0064740Medicaid