1629090758 NPI number — ALLERGY AND ASTHMA CONSULTANTS OF MONTANA, PLLC

Table of content: QUINN VI TANG P.A., L.AC., DACM (NPI 1033153572)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629090758 NPI number — ALLERGY AND ASTHMA CONSULTANTS OF MONTANA, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLERGY AND ASTHMA CONSULTANTS OF MONTANA, PLLC
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:
1629090758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2055 N 22ND AVE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
BOZEMAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59718-2783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-582-1111
Provider Business Mailing Address Fax Number:
406-582-1112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 N 22ND AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59718-2783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-582-1111
Provider Business Practice Location Address Fax Number:
406-582-1112
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WANDERER
Authorized Official First Name:
PAT
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
406-582-1111

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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