Basic Information
| Provider Information | |||||||||
| NPI: | 1366066250 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLUE CREEK ANESTHESIOLOGY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1155 | ||||||||
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| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591031155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064832902 | ||||||||
| FaxNumber: | 4062483346 | ||||||||
| Practice Location | |||||||||
| Address1: | 940 N 30TH ST | ||||||||
| Address2: | |||||||||
| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591010742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062483290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2020 | ||||||||
| LastUpdateDate: | 06/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | WARREN | ||||||||
| AuthorizedOfficialFirstName: | MARVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNDER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4062488953 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.