Provider Demographics
NPI:1497896229
Name:ASSOCIATED DERMATOLOGY AND SKIN CANCER CLINIC OF HELENA, PC
Entity Type:Organization
Organization Name:ASSOCIATED DERMATOLOGY AND SKIN CANCER CLINIC OF HELENA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:GOLDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-442-3534
Mailing Address - Street 1:50 S LAST CHANCE GULCH
Mailing Address - Street 2:SUITE 3
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4130
Mailing Address - Country:US
Mailing Address - Phone:406-442-3534
Mailing Address - Fax:406-442-2064
Practice Address - Street 1:50 SOUTH LAST CHANCE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4130
Practice Address - Country:US
Practice Address - Phone:406-442-3534
Practice Address - Fax:406-442-2064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC8656OtherRAILROAD MCR
MT000080330Medicare PIN