1164049623 NPI number — MONTANA MASTER BUILDERS LTD. CO.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164049623 NPI number — MONTANA MASTER BUILDERS LTD. CO.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTANA MASTER BUILDERS LTD. CO.
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:
Provider Other Organization Name Type Code:
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:
1164049623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 803
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMILTON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59840-0803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-381-8928
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1487 IRON CAP DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEVENSVILLE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59870-6640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-381-8928
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/01/2020

Additional Information

Authorized Official

Authorized Official Last Name:
EBERLEIN
Authorized Official First Name:
ROSS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
406-381-8928

Provider Taxonomy Codes

  • Taxonomy code: 171W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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