Provider Demographics
NPI:1922604693
Name:OHANA PROVIDERS, PLLC
Entity Type:Organization
Organization Name:OHANA PROVIDERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BODNAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-290-9769
Mailing Address - Street 1:111 N HIGGINS AVE STE 600/ P.O. BOX 4747
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4494
Mailing Address - Country:US
Mailing Address - Phone:206-406-6729
Mailing Address - Fax:
Practice Address - Street 1:111 N HIGGINS AVE STE 600
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4494
Practice Address - Country:US
Practice Address - Phone:206-406-6729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center