1790285062 NPI number — FRANK LOUIS BELGARDE JR. BA, AA, LAC

Table of content: FRANK LOUIS BELGARDE JR. BA, AA, LAC (NPI 1790285062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790285062 NPI number — FRANK LOUIS BELGARDE JR. BA, AA, LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELGARDE
Provider First Name:
FRANK
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
BA, AA, LAC
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:
1790285062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/31/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4802
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59604-4802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-909-4053
Provider Business Mailing Address Fax Number:
406-302-5022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 S EWING ST STE 408
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601-6072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-909-4053
Provider Business Practice Location Address Fax Number:
406-302-5022
Provider Enumeration Date:
02/13/2018

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: 101YA0400X , with the licence number:  BBH-LAC-LIC-38101 , 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)





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