Provider Demographics
NPI:1598862872
Name:HUGH HETHERINGTON, M.D., P.C.
Entity Type:Organization
Organization Name:HUGH HETHERINGTON, M.D., P.C.
Other - Org Name:BIG SKY EAR, NOSE AND THROAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:ELLIOTT
Authorized Official - Last Name:HETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-587-5000
Mailing Address - Street 1:925 HIGHLAND BLVD
Mailing Address - Street 2:SUITE 1160
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6900
Mailing Address - Country:US
Mailing Address - Phone:406-587-5000
Mailing Address - Fax:406-587-5068
Practice Address - Street 1:925 HIGHLAND BLVD
Practice Address - Street 2:SUITE 1160
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6900
Practice Address - Country:US
Practice Address - Phone:406-587-5000
Practice Address - Fax:406-587-5068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10377207Y00000X
MT6361207YX0905X
MTMT CERTIFICATE # U97231H00000X
MT#332HAD237700000X
MT227363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Not Answered207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT101847Medicaid
MT0064430Medicaid
MT5606198Medicaid
MT0533307Medicaid
MT435383Medicaid
MT101847Medicaid
MT0064430Medicaid
MT#F65007Medicare UPIN