Provider Demographics
NPI:1639150956
Name:FOOT AND ANKLE CLINIC OF MONTANA
Entity Type:Organization
Organization Name:FOOT AND ANKLE CLINIC OF MONTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:G
Authorized Official - Last Name:CLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:406-761-2222
Mailing Address - Street 1:1301 11TH AVE S
Mailing Address - Street 2:EVERGREEN MALL
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4654
Mailing Address - Country:US
Mailing Address - Phone:406-761-2222
Mailing Address - Fax:406-761-7219
Practice Address - Street 1:1301 11TH AVE S
Practice Address - Street 2:EVERGREEN MALL
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4654
Practice Address - Country:US
Practice Address - Phone:406-761-2222
Practice Address - Fax:406-761-7219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT75213E00000X
MT122213E00000X
MT800PT225100000X
MT1558PT225100000X
MT1071PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty