Provider Demographics
NPI:1487662334
Name:ST PETERS HOSPITAL
Entity Type:Organization
Organization Name:ST PETERS HOSPITAL
Other - Org Name:HELENA EAR NOSE AND THROAT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF PHYSICIAN SERVICE
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:406-447-2812
Mailing Address - Street 1:PO BOX 6369
Mailing Address - Street 2:ST PETERS HOSPITAL PHYSICIAN BILLING
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604
Mailing Address - Country:US
Mailing Address - Phone:406-447-2828
Mailing Address - Fax:406-447-2825
Practice Address - Street 1:2525 BROADWAY
Practice Address - Street 2:SUITE 105 HELENA EAR NOSE AND THROAT CLINIC
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-457-4160
Practice Address - Fax:406-457-4179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty