1154460434 NPI number — UNIVERSITY OF MONTANA

Table of content: (NPI 1154460434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154460434 NPI number — UNIVERSITY OF MONTANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF MONTANA
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:
1154460434
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 SW HIGGINS AVE.,
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59803-3602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-243-5769
Provider Business Mailing Address Fax Number:
406-243-4730

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 SW HIGGINS AVE.,
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59803-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-243-5769
Provider Business Practice Location Address Fax Number:
406-243-4730
Provider Enumeration Date:
02/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLAIR
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
406-243-4779

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0005602095 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 600627 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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