Provider Demographics
NPI:1891308193
Name:MZ VIKKIS LLC
Entity Type:Organization
Organization Name:MZ VIKKIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL AGENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DELONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-226-7065
Mailing Address - Street 1:1212 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-0907
Mailing Address - Country:US
Mailing Address - Phone:406-449-5100
Mailing Address - Fax:
Practice Address - Street 1:1212 CEDAR ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-0907
Practice Address - Country:US
Practice Address - Phone:406-449-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals