Provider Demographics
NPI:1811062870
Name:ADVANCED NEUROLOGY SPECIALISTS PLLC
Entity type:Organization
Organization Name:ADVANCED NEUROLOGY SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENNING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:406-727-3720
Mailing Address - Street 1:400 15TH AVE S STE 206
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4375
Mailing Address - Country:US
Mailing Address - Phone:406-727-3720
Mailing Address - Fax:
Practice Address - Street 1:400 15TH AVE S STE 206
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4375
Practice Address - Country:US
Practice Address - Phone:406-727-3720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000084371Medicare PIN