Provider Demographics
NPI:1457365397
Name:NORTHEASTERN MONTANA ORTHOPAEDICS
Entity Type:Organization
Organization Name:NORTHEASTERN MONTANA ORTHOPAEDICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-228-4331
Mailing Address - Street 1:621 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:MT
Mailing Address - Zip Code:59230-2604
Mailing Address - Country:US
Mailing Address - Phone:406-228-4331
Mailing Address - Fax:406-228-3287
Practice Address - Street 1:621 3RD ST S
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:MT
Practice Address - Zip Code:59230-2604
Practice Address - Country:US
Practice Address - Phone:406-228-4331
Practice Address - Fax:406-228-3287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4034428002WTH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty