Provider Demographics
NPI:1841474087
Name:DANIEL C BROOKE MD PC
Entity type:Organization
Organization Name:DANIEL C BROOKE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-233-2520
Mailing Address - Street 1:2600 WILSON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MILES CITY
Mailing Address - State:MT
Mailing Address - Zip Code:59301-5094
Mailing Address - Country:US
Mailing Address - Phone:406-233-2520
Mailing Address - Fax:
Practice Address - Street 1:2600 WILSON STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301
Practice Address - Country:US
Practice Address - Phone:406-233-2520
Practice Address - Fax:406-233-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-24
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BC3200X
MT4617207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTDA5107OtherRAILROAD MEDICARE
MT1841474087OtherDMERC NORIDIAN MEDICARE
MT1841474087Medicaid
MT1841474087Medicaid
MT1841474087Medicare NSC
MT1841474087OtherDMERC NORIDIAN MEDICARE
MT0000083883Medicare NSC