Provider Demographics
NPI:1821033051
Name:SPECTRUM HOME SOLUTIONS
Entity Type:Organization
Organization Name:SPECTRUM HOME SOLUTIONS
Other - Org Name:SPECTRUM HOME SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILHELM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-727-1218
Mailing Address - Street 1:2509 7TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3030
Mailing Address - Country:US
Mailing Address - Phone:406-727-1218
Mailing Address - Fax:406-727-6010
Practice Address - Street 1:2509 7TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3030
Practice Address - Country:US
Practice Address - Phone:406-727-1218
Practice Address - Fax:406-727-6010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336H0001X
MTPHA-PHR-LIC-817332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT220883Medicaid
2051872OtherPK
MT5605665Medicaid
MT5606617Medicaid
2051872OtherPK