Provider Demographics
NPI:1801072624
Name:NORTHWEST MONTANA SURGICAL ASSOCIATES, P.C.
Entity type:Organization
Organization Name:NORTHWEST MONTANA SURGICAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MILHEIM
Authorized Official - Middle Name:G
Authorized Official - Last Name:STEPHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-752-5000
Mailing Address - Street 1:308 LOUISIANA AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-2158
Mailing Address - Country:US
Mailing Address - Phone:406-293-2136
Mailing Address - Fax:406-293-2936
Practice Address - Street 1:308 LOUISIANA AVE
Practice Address - Street 2:STE 1
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2158
Practice Address - Country:US
Practice Address - Phone:406-293-2136
Practice Address - Fax:406-293-2936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8804208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000081523Medicare PIN