Provider Demographics
NPI:1457486276
Name:INTERMOUNTAIN NEUROLOGY PC
Entity Type:Organization
Organization Name:INTERMOUNTAIN NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-922-2770
Mailing Address - Street 1:650 FERGUSON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6518
Mailing Address - Country:US
Mailing Address - Phone:406-922-2770
Mailing Address - Fax:406-922-2771
Practice Address - Street 1:650 FERGUSON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6518
Practice Address - Country:US
Practice Address - Phone:406-922-2770
Practice Address - Fax:406-922-2771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT104702084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000084273Medicare ID - Type Unspecified