1275668071 NPI number — BILLINGS FOOT AND ANKLE

Table of content: (NPI 1275668071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275668071 NPI number — BILLINGS FOOT AND ANKLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BILLINGS FOOT AND ANKLE
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:
1275668071
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
71 25TH ST W
Provider Second Line Business Mailing Address:
PO BOX 20919
Provider Business Mailing Address City Name:
BILLINGS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59102-4684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-651-0767
Provider Business Mailing Address Fax Number:
406-652-0174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71 25TH ST W
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59102-4684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-651-0767
Provider Business Practice Location Address Fax Number:
406-652-0174
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OURADNIK
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
406-651-0767

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X , with the licence number:  162 , 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: DC5626 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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