Provider Demographics
NPI:1760647820
Name:MISSOULA SLEEP MEDICINE, LLC
Entity Type:Organization
Organization Name:MISSOULA SLEEP MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-829-8053
Mailing Address - Street 1:910 BROOKS ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5783
Mailing Address - Country:US
Mailing Address - Phone:406-829-8053
Mailing Address - Fax:406-541-8062
Practice Address - Street 1:910 BROOKS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5783
Practice Address - Country:US
Practice Address - Phone:406-829-8053
Practice Address - Fax:406-541-8062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011001878Medicare PIN