1548488265 NPI number — FAMILY PRACTICE ASSOCIATES PC

Table of content: (NPI 1548488265)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548488265 NPI number — FAMILY PRACTICE ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PRACTICE ASSOCIATES PC
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:
1548488265
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/15/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
935 HIGHLAND BLVD
Provider Second Line Business Mailing Address:
SUITE 2210
Provider Business Mailing Address City Name:
BOZEMAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59715-6904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-587-3133
Provider Business Mailing Address Fax Number:
406-596-9671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
935 HIGHLAND BLVD
Provider Second Line Business Practice Location Address:
SUITE 2210
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59715-6904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-587-3133
Provider Business Practice Location Address Fax Number:
406-596-9671
Provider Enumeration Date:
04/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HILDNER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
406-587-3133

Provider Taxonomy Codes

  • Taxonomy code: 207QH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9986276 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: C01394 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0404320001 . This is a "DMERC" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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