Provider Demographics
NPI:1902823917
Name:HELENA ORTHOPAEDIC CLINIC
Entity Type:Organization
Organization Name:HELENA ORTHOPAEDIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BOYD
Authorized Official - Middle Name:M
Authorized Official - Last Name:IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-457-4100
Mailing Address - Street 1:2442 WINNE AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4915
Mailing Address - Country:US
Mailing Address - Phone:406-457-4100
Mailing Address - Fax:406-457-4110
Practice Address - Street 1:2442 WINNE AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4921
Practice Address - Country:US
Practice Address - Phone:406-457-4100
Practice Address - Fax:406-457-4110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT3905400001OtherM-CARE PTAN #
MT000080544Medicare PIN