Provider Demographics
NPI:1942361258
Name:PROFESSIONAL CENTER LLP
Entity Type:Organization
Organization Name:PROFESSIONAL CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-892-3208
Mailing Address - Street 1:PO BOX 1459
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-1459
Mailing Address - Country:US
Mailing Address - Phone:406-892-3208
Mailing Address - Fax:
Practice Address - Street 1:2165 9TH ST W
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-4416
Practice Address - Country:US
Practice Address - Phone:406-892-3208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT=========OtherTAX ID
MT000008468Medicare ID - Type Unspecified