1457860389 NPI number — TREASURE STATE ORTHOTIC & PROSTHETIC CLINIC, INC

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 1457860389 NPI number — TREASURE STATE ORTHOTIC & PROSTHETIC CLINIC, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TREASURE STATE ORTHOTIC & PROSTHETIC CLINIC, INC
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:
1457860389
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1648 ELLIS ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
BOZEMAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59715-8810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-585-1440
Provider Business Mailing Address Fax Number:
406-585-1438

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
436 W PORPHYRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTTE
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59701-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-782-2515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MURFITT
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
Authorized Official Title or Position:
HR/AP DIRECTOR
Authorized Official Telephone Number:
406-585-1440

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5607407 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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