Provider Demographics
NPI:1619429511
Name:MONTANA CARDIOTHORACIC ASSIST
Entity Type:Organization
Organization Name:MONTANA CARDIOTHORACIC ASSIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:928-846-5869
Mailing Address - Street 1:306 S MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425-2412
Mailing Address - Country:US
Mailing Address - Phone:928-846-5869
Mailing Address - Fax:
Practice Address - Street 1:306 S MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-2412
Practice Address - Country:US
Practice Address - Phone:928-846-5869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-43492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty