Basic Information
| Provider Information | |||||||||
| NPI: | 1306857917 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCKY MOUNTAIN EAR NOSE & THROAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 WEST KENT | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065413277 | ||||||||
| FaxNumber: | 4065413950 | ||||||||
| Practice Location | |||||||||
| Address1: | 700 WEST KENT | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598017000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4065413277 | ||||||||
| FaxNumber: | 4065413950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | BROE, CPC, CPPM, OCS | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4065413806 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.