Provider Demographics
NPI:1922303155
Name:RICHARD S BUSWELL MD PC
Entity Type:Organization
Organization Name:RICHARD S BUSWELL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUSWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-442-0507
Mailing Address - Street 1:2600 WINNE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4900
Mailing Address - Country:US
Mailing Address - Phone:406-442-0507
Mailing Address - Fax:406-442-0501
Practice Address - Street 1:2600 WINNE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4900
Practice Address - Country:US
Practice Address - Phone:406-442-0507
Practice Address - Fax:406-442-0501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0029562Medicaid
MTM011100554OtherPTAN