Provider Demographics
NPI:1205326873
Name:MONTANA NEUROLOGY PLLC
Entity type:Organization
Organization Name:MONTANA NEUROLOGY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-274-2295
Mailing Address - Street 1:2825 FORT MISSOULA RD STE 121
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7403
Mailing Address - Country:US
Mailing Address - Phone:406-926-3500
Mailing Address - Fax:406-926-3499
Practice Address - Street 1:2040 GRAND RIVER ANX STE 200
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114
Practice Address - Country:US
Practice Address - Phone:248-328-5361
Practice Address - Fax:406-926-3498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTANA NEUROLOGY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-18
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty