Provider Demographics
NPI:1710931225
Name:MISSOULA ANESTHESIOLOGY, P.C.
Entity Type:Organization
Organization Name:MISSOULA ANESTHESIOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:P
Authorized Official - Last Name:GILLETT-BRETZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-728-8420
Mailing Address - Street 1:PO BOX 94484
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6784
Mailing Address - Country:US
Mailing Address - Phone:406-728-8420
Mailing Address - Fax:406-541-8430
Practice Address - Street 1:2825 STOCKYARD RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1503
Practice Address - Country:US
Practice Address - Phone:406-728-8420
Practice Address - Fax:406-541-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID05041300Medicaid
WY114103100Medicaid
ID05041300Medicaid
ID05041300Medicaid
WA7098544Medicaid