Provider Demographics
NPI:1952797243
Name:MOMENTUM PROSTHETIC CLINIC LLC
Entity Type:Organization
Organization Name:MOMENTUM PROSTHETIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFFORD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:CREEKMORE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:406-529-0474
Mailing Address - Street 1:3817 STEPHENS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-8505
Mailing Address - Country:US
Mailing Address - Phone:406-926-1321
Mailing Address - Fax:406-926-1327
Practice Address - Street 1:3817 STEPHENS AVE STE 2
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-8542
Practice Address - Country:US
Practice Address - Phone:406-926-1321
Practice Address - Fax:406-926-1327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2015-MSS-GEN-00092335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier