Provider Demographics
NPI:1265899983
Name:EDWARD WINGFIELD LLC
Entity type:Organization
Organization Name:EDWARD WINGFIELD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-922-5060
Mailing Address - Street 1:502 S 19TH AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4055
Mailing Address - Country:US
Mailing Address - Phone:406-922-5060
Mailing Address - Fax:
Practice Address - Street 1:502 S 19TH AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4055
Practice Address - Country:US
Practice Address - Phone:406-922-5060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT16-34655253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care