Provider Demographics
NPI:1508312059
Name:MONTANA WHOLE HEALTH
Entity Type:Organization
Organization Name:MONTANA WHOLE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:ISABELLA
Authorized Official - Last Name:KRUMBECK
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:406-552-5041
Mailing Address - Street 1:2835 FORT MISSOULA RD, STE 306
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7424
Mailing Address - Country:US
Mailing Address - Phone:406-552-1717
Mailing Address - Fax:406-203-5130
Practice Address - Street 1:2835 FORT MISSOULA RD, STE 306
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7424
Practice Address - Country:US
Practice Address - Phone:406-552-1717
Practice Address - Fax:406-203-5130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-25
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTAHC-NAT-LIC-811261QM2500X, 261QP2300X
261QM2500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care