Provider Demographics
NPI:1922007202
Name:ANESTHESIA ASSOCIATES OF GREAT FALLS LLC
Entity Type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF GREAT FALLS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-727-6311
Mailing Address - Street 1:401 15TH AVE S
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4334
Mailing Address - Country:US
Mailing Address - Phone:406-727-6311
Mailing Address - Fax:406-727-1070
Practice Address - Street 1:401 15TH AVE S
Practice Address - Street 2:SUITE 109
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4334
Practice Address - Country:US
Practice Address - Phone:406-727-6311
Practice Address - Fax:406-727-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4764,5327,8985,9832207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT68884Medicaid
MT68867Medicaid
MT68901Medicaid
MT68918Medicaid
MT68850Medicaid
MT69003Medicaid
D07998Medicare UPIN
D90350Medicare UPIN
G72705Medicare UPIN
A47907Medicare UPIN
G69396Medicare UPIN
MT69003Medicaid
A49457Medicare UPIN
83183Medicare ID - Type Unspecified
MT68918Medicaid
MT68867Medicaid
MT68850Medicaid
E39387Medicare UPIN
H64392Medicare UPIN
MT68901Medicaid