Provider Demographics
NPI:1851545594
Name:THOMAS A. BAUMGARTNER MD PC
Entity Type:Organization
Organization Name:THOMAS A. BAUMGARTNER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARICELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-542-2116
Mailing Address - Street 1:2825 FORT MISSOULA RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7420
Mailing Address - Country:US
Mailing Address - Phone:406-542-2116
Mailing Address - Fax:406-542-1425
Practice Address - Street 1:2825 FORT MISSOULA RD
Practice Address - Street 2:SUITE 304
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7420
Practice Address - Country:US
Practice Address - Phone:406-542-2116
Practice Address - Fax:406-542-1425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4051174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
160055069OtherMEDICARE RAILROAD
000011090OtherBCBS
MT0056784Medicaid
MT0056784Medicaid