Provider Demographics
NPI:1649300534
Name:FLATHEAD UROLOGY, PLLC
Entity type:Organization
Organization Name:FLATHEAD UROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-756-1433
Mailing Address - Street 1:210 SUNNYVIEW LN
Mailing Address - Street 2:SUITE 106
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3135
Mailing Address - Country:US
Mailing Address - Phone:406-756-1433
Mailing Address - Fax:406-756-1446
Practice Address - Street 1:210 SUNNYVIEW LN
Practice Address - Street 2:SUITE 106
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3135
Practice Address - Country:US
Practice Address - Phone:406-756-1433
Practice Address - Fax:406-756-1446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center