Provider Demographics
NPI:1558485821
Name:EAGLE MOUNT - GREAT FALLS
Entity Type:Organization
Organization Name:EAGLE MOUNT - GREAT FALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-454-1449
Mailing Address - Street 1:9 3RD ST N STE 1
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3145
Mailing Address - Country:US
Mailing Address - Phone:406-454-1449
Mailing Address - Fax:406-454-1780
Practice Address - Street 1:4792 13TH ST S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-8127
Practice Address - Country:US
Practice Address - Phone:406-454-1449
Practice Address - Fax:406-454-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3402244Medicaid
MT345134Medicaid
MT3400605Medicaid