Provider Demographics
NPI:1821327008
Name:MARK IBSEN INC
Entity Type:Organization
Organization Name:MARK IBSEN INC
Other - Org Name:URGENT CARE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:IBSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-513-1052
Mailing Address - Street 1:39 NEILL AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3330
Mailing Address - Country:US
Mailing Address - Phone:406-513-1052
Mailing Address - Fax:406-513-1054
Practice Address - Street 1:39 NEILL AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3330
Practice Address - Country:US
Practice Address - Phone:406-513-1052
Practice Address - Fax:406-513-1054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7378207PE0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT104958Medicaid
MT000080499OtherMEDICARE ID-TYPE UNSPECIFIED
MT104958Medicaid