Provider Demographics
NPI:1801970033
Name:WILDHORSE MANAGEMENT INC
Entity type:Organization
Organization Name:WILDHORSE MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAMSCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-826-4853
Mailing Address - Street 1:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-1310
Mailing Address - Country:US
Mailing Address - Phone:406-826-4853
Mailing Address - Fax:
Practice Address - Street 1:CLARKFORK VALLEY HOSPITAL
Practice Address - Street 2:#10 KRUGER RD
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859
Practice Address - Country:US
Practice Address - Phone:406-826-4853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7969208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC5784Medicare ID - Type UnspecifiedRR MEDICARE
MT83660Medicare ID - Type UnspecifiedMONTANA MEDICARE