1922699644 NPI number — MONTANA MEDICAL RESEARCH, INC

Table of content: (NPI 1922699644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922699644 NPI number — MONTANA MEDICAL RESEARCH, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTANA MEDICAL RESEARCH, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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NPI Number Information

NPI Number:
1922699644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2373 PALMER
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-549-1124
Provider Business Mailing Address Fax Number:
406-542-0512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2373 PALMER
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-549-1124
Provider Business Practice Location Address Fax Number:
406-542-0512
Provider Enumeration Date:
01/27/2021

Additional Information

Authorized Official

Authorized Official Last Name:
HEGEL
Authorized Official First Name:
MARRIA
Authorized Official Middle Name:
Authorized Official Title or Position:
RESEARCH DIRECTOR
Authorized Official Telephone Number:
406-549-1124

Provider Taxonomy Codes

  • Taxonomy code: 1744R1102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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