1518902881 NPI number — ROSE OSTEOPATHIC 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 1518902881 NPI number — ROSE OSTEOPATHIC CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROSE OSTEOPATHIC 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:
6
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:
1518902881
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
54699 HILLSIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST IGNATIUS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59865-8915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-745-0845
Provider Business Mailing Address Fax Number:
406-204-3238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
54699 HILLSIDE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST IGNATIUS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59865-8915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-745-0845
Provider Business Practice Location Address Fax Number:
833-918-2217
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSE
Authorized Official First Name:
DHARMA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
406-745-0845

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  02001899 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X , with the licence number: MED-PHYS-LIC-53457 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1518902881 . This is a "BCBS MONTANA PROVIDER IDENTIFIER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200977140A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1518902881 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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