Provider Demographics
NPI:1497733471
Name:NORTHERN ROCKIES NEUROSURGEONS PLLC
Entity Type:Organization
Organization Name:NORTHERN ROCKIES NEUROSURGEONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:NORDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-237-5760
Mailing Address - Street 1:2900 12TH AVE N
Mailing Address - Street 2:SUITE 340 W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7506
Mailing Address - Country:US
Mailing Address - Phone:406-237-5760
Mailing Address - Fax:406-237-5799
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:SUITE 340 W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-237-5760
Practice Address - Fax:406-237-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY20321Medicare ID - Type Unspecified