Provider Demographics
NPI:1013236603
Name:CARON CORPORATION
Entity Type:Organization
Organization Name:CARON CORPORATION
Other - Org Name:PMG WMT FRENCHTOWN FAMILY MED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO ST PATRICK HOSPITAL WMSA REGION
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-329-5868
Mailing Address - Street 1:PO BOX 34439
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1439
Mailing Address - Country:US
Mailing Address - Phone:425-525-6694
Mailing Address - Fax:
Practice Address - Street 1:16862 BECKWITH ST
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:MT
Practice Address - Zip Code:59834-9646
Practice Address - Country:US
Practice Address - Phone:406-626-5769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011004293Medicare PIN