Provider Demographics
NPI:1528413093
Name:ROCKY MOUNTAIN VEIN CLINIC GREAT FALLS INC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN VEIN CLINIC GREAT FALLS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:406-252-8346
Mailing Address - Street 1:1400 29TH ST S STE 201
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5316
Mailing Address - Country:US
Mailing Address - Phone:406-727-8346
Mailing Address - Fax:
Practice Address - Street 1:1400 29TH ST S STE 201
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5316
Practice Address - Country:US
Practice Address - Phone:406-727-8346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10772208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty