Provider Demographics
NPI:1952475469
Name:ORTHOPEDICS OF CENTRAL MT PC
Entity Type:Organization
Organization Name:ORTHOPEDICS OF CENTRAL MT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:IANNACONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-538-1456
Mailing Address - Street 1:310 WENDELL AVENUE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LEWISTOWN
Mailing Address - State:MT
Mailing Address - Zip Code:59457-2267
Mailing Address - Country:US
Mailing Address - Phone:406-538-1456
Mailing Address - Fax:406-538-1422
Practice Address - Street 1:310 WENDELL AVENUE
Practice Address - Street 2:SUITE 5
Practice Address - City:LEWISTOWN
Practice Address - State:MT
Practice Address - Zip Code:59457-2267
Practice Address - Country:US
Practice Address - Phone:406-538-1456
Practice Address - Fax:406-538-1422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT610577800OtherDEPARTMENT OF LABOR
MT0000144274Medicaid
DD6429Medicare PIN
MT610577800OtherDEPARTMENT OF LABOR
MT000084708Medicare ID - Type Unspecified