1104857028 NPI number — ARNT JAMES OFSTAD, P.C.

Table of content: (NPI 1104857028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104857028 NPI number — ARNT JAMES OFSTAD, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARNT JAMES OFSTAD, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RONAN EYE CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104857028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
417 MAIN ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RONAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59864-2738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-676-8921
Provider Business Mailing Address Fax Number:
406-676-3938

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
417 MAIN ST SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RONAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59864-2738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-676-8921
Provider Business Practice Location Address Fax Number:
406-676-3938
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OFSTAD
Authorized Official First Name:
ARNT
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER/DOCTOR
Authorized Official Telephone Number:
406-676-8921

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  381OPT , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , with the licence number: 381OPT , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DG6082 . This is a "MEDICARE ID TYPE UNSPEC" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 000026180 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 011000679 . This is a "MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0489268 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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