Provider Demographics
NPI:1003569112
Name:MISSION MOUNTAINS OSTEOPATHY
Entity type:Organization
Organization Name:MISSION MOUNTAINS OSTEOPATHY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DHARMA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:406-745-0845
Mailing Address - Street 1:54699 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:ST IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-8915
Mailing Address - Country:US
Mailing Address - Phone:406-745-0845
Mailing Address - Fax:406-204-3238
Practice Address - Street 1:54699 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:ST IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-8915
Practice Address - Country:US
Practice Address - Phone:406-745-0845
Practice Address - Fax:406-204-3238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty