Provider Demographics
NPI:1689915456
Name:JOHN G VANGILDER PLLC
Entity Type:Organization
Organization Name:JOHN G VANGILDER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:VANGILDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-452-9504
Mailing Address - Street 1:401 15TH AVE S STE 101
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4372
Mailing Address - Country:US
Mailing Address - Phone:406-452-9504
Mailing Address - Fax:
Practice Address - Street 1:401 15TH AVE S STE 101
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4372
Practice Address - Country:US
Practice Address - Phone:406-452-9504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10372207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0063682Medicaid
MT0063682Medicaid