Basic Information
| Provider Information | |||||||||
| NPI: | 1487724399 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PONDERA MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 SUNSET BLVD. | ||||||||
| Address2: | PO BOX 758 | ||||||||
| City: | CONRAD | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594250758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062712202 | ||||||||
| FaxNumber: | 4062713917 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 SUNSET BLVD. | ||||||||
| Address2: | |||||||||
| City: | CONRAD | ||||||||
| State: | MT | ||||||||
| PostalCode: | 594250758 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062712202 | ||||||||
| FaxNumber: | 4062713917 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | CHRISTENSEN | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | JIM | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4062712202 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.