Provider Demographics
NPI:1982463147
Name:MONTANA HEADACHE CLINIC
Entity Type:Organization
Organization Name:MONTANA HEADACHE CLINIC
Other - Org Name:MONTANA HEADACHE CLINIC PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:MCGEE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:406-215-2755
Mailing Address - Street 1:5990 COCHISE DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-9501
Mailing Address - Country:US
Mailing Address - Phone:406-215-2755
Mailing Address - Fax:
Practice Address - Street 1:2831 FORT MISSOULA RD
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7419
Practice Address - Country:US
Practice Address - Phone:406-215-2755
Practice Address - Fax:406-625-7110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-18
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty