Provider Demographics
NPI:1679550107
Name:MONTANA PLAINS REHABILITATION PC
Entity Type:Organization
Organization Name:MONTANA PLAINS REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BILL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TACKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-455-2140
Mailing Address - Street 1:500 15TH AVE S
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4304
Mailing Address - Country:US
Mailing Address - Phone:406-455-2140
Mailing Address - Fax:406-455-2141
Practice Address - Street 1:500 15TH AVE S
Practice Address - Street 2:SUITE ONE
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4304
Practice Address - Country:US
Practice Address - Phone:406-455-2149
Practice Address - Fax:406-455-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-27
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C01336OtherRR MEDICARE
MT000008396Medicare ID - Type Unspecified