Provider Demographics
NPI:1801209655
Name:FREEEMAN, RICHARD WAYNE (BS MT(ASCP))
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:WAYNE
Last Name:FREEEMAN
Suffix:
Gender:M
Credentials:BS MT(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 6TH AVE NORTH
Mailing Address - Street 2:P.O. BOX 729
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-0729
Mailing Address - Country:US
Mailing Address - Phone:406-653-1641
Mailing Address - Fax:406-653-3728
Practice Address - Street 1:550 6TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-0729
Practice Address - Country:US
Practice Address - Phone:406-653-1641
Practice Address - Fax:406-653-3728
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK190326246RM2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT9990118Medicaid