1659763217 NPI number — MONTANA RX SOLUTIONS, PLLC

Table of content: (NPI 1659763217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659763217 NPI number — MONTANA RX SOLUTIONS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTANA RX SOLUTIONS, 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:
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:
1659763217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59019-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6230 MAIN ST
Provider Second Line Business Practice Location Address:
STE. B101
Provider Business Practice Location Address City Name:
COLSTRIP
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59323-9520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-213-7010
Provider Business Practice Location Address Fax Number:
406-213-7009
Provider Enumeration Date:
02/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MATOVICH
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
MEMBER, MONTANA RX SOLUTIONS, PLLC
Authorized Official Telephone Number:
406-860-4044

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHA-PHR-LIC-28412 , 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: 1659763217 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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