1376574871 NPI number — MARC C MENTEL DO

Table of content: MARC C MENTEL DO (NPI 1376574871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376574871 NPI number — MARC C MENTEL DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MENTEL
Provider First Name:
MARC
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1376574871
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
96 N WEAVER ST UNIT 440
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELGRADE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59714-7018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-219-7233
Provider Business Mailing Address Fax Number:
888-798-0145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 WYOMING ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59801-1727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-532-9900
Provider Business Practice Location Address Fax Number:
406-532-9901
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  10584 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 10584 , 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: 0079186 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com