Basic Information
| Provider Information | |||||||||
| NPI: | 1184758005 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ORTHO MONTANA, PSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 12TH AVE N STE 140W | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591017507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062375050 | ||||||||
| FaxNumber: | 4062386599 | ||||||||
| Practice Location | |||||||||
| Address1: | 2900 12TH AVE N | ||||||||
| Address2: | SUITE 140W | ||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591017506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062386540 | ||||||||
| FaxNumber: | 4062386599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 12/30/2019 | ||||||||
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| AuthorizedOfficialLastName: | SHENTON | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 4062375050 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 12/30/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.