Provider Demographics
NPI:1013074939
Name:WESTERN STATES INFECTIOUS DISEASES PC
Entity Type:Organization
Organization Name:WESTERN STATES INFECTIOUS DISEASES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:F
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-327-4405
Mailing Address - Street 1:2831 FORT MISSOULA RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7479
Mailing Address - Country:US
Mailing Address - Phone:406-327-4405
Mailing Address - Fax:406-327-4477
Practice Address - Street 1:2831 FORT MISSOULA RD
Practice Address - Street 2:SUITE 301
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7479
Practice Address - Country:US
Practice Address - Phone:406-327-4405
Practice Address - Fax:406-327-4477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT6612174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000082500Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER