Provider Demographics
NPI:1811089568
Name:RO MONTANA
Entity type:Organization
Organization Name:RO MONTANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:E
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:406-761-8781
Mailing Address - Street 1:1417 9TH ST S
Mailing Address - Street 2:SUITE 101A
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:58405
Mailing Address - Country:US
Mailing Address - Phone:406-452-7676
Mailing Address - Fax:406-452-0435
Practice Address - Street 1:1417 9TH ST S
Practice Address - Street 2:SUITE 101A
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:58405
Practice Address - Country:US
Practice Address - Phone:406-452-7676
Practice Address - Fax:406-452-0435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0562513Medicaid
0214251OtherPROVIDER
0214251OtherPROVIDER