Provider Demographics
NPI:1952668212
Name:MONTANA ANESTHESIA PLLC
Entity Type:Organization
Organization Name:MONTANA ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SMAGULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-750-7379
Mailing Address - Street 1:465 FLOOD RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-6403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:465 FLOOD RD
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-6403
Practice Address - Country:US
Practice Address - Phone:406-750-7379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR-48734282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
1139913Medicare PIN
G76131Medicare UPIN