Provider Demographics
NPI:1467657965
Name:MONTANA CARDIAC INSTITUTE
Entity Type:Organization
Organization Name:MONTANA CARDIAC INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIRAGUSA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-782-4531
Mailing Address - Street 1:401 S ALABAMA ST STE 9
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2358
Mailing Address - Country:US
Mailing Address - Phone:406-782-4531
Mailing Address - Fax:
Practice Address - Street 1:401 S ALABAMA ST STE 9
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2358
Practice Address - Country:US
Practice Address - Phone:406-782-4531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9733207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0046384Medicaid
MTA44371Medicare UPIN