Provider Demographics
NPI:1861504102
Name:BITTERROOT ANESTHESIOLOGY
Entity Type:Organization
Organization Name:BITTERROOT ANESTHESIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANIG
Authorized Official - Suffix:
Authorized Official - Credentials:CPC, CHBME
Authorized Official - Phone:406-443-3076
Mailing Address - Street 1:150 STRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-5719
Mailing Address - Country:US
Mailing Address - Phone:406-370-9308
Mailing Address - Fax:406-449-6531
Practice Address - Street 1:150 STRAND AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-5719
Practice Address - Country:US
Practice Address - Phone:406-370-9308
Practice Address - Fax:406-449-6531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9615207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G74893Medicare UPIN