Provider Demographics
NPI:1639886823
Name:MOUNTAIN WEST PLASTIC SURGERY AND MEDICAL SPA, PLLC
Entity Type:Organization
Organization Name:MOUNTAIN WEST PLASTIC SURGERY AND MEDICAL SPA, PLLC
Other - Org Name:MOUNTAIN WEST PLASTIC SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-609-0210
Mailing Address - Street 1:60 FOUR MILE DR STE 11
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2663
Mailing Address - Country:US
Mailing Address - Phone:406-609-0210
Mailing Address - Fax:406-609-0211
Practice Address - Street 1:60 FOUR MILE DR STE 11
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2663
Practice Address - Country:US
Practice Address - Phone:406-609-0210
Practice Address - Fax:406-609-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-28
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty