Basic Information
Provider Information | |||||||||
NPI: | 1861677981 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | KRISTIN A RAUCH MD PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2825 FORT MISSOULA RD | ||||||||
Address2: | 115 | ||||||||
City: | MISSOULA | ||||||||
State: | MT | ||||||||
PostalCode: | 598047420 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4067284292 | ||||||||
FaxNumber: | 4067285770 | ||||||||
Practice Location | |||||||||
Address1: | 2825 FORT MISSOULA RD | ||||||||
Address2: | 115 | ||||||||
City: | MISSOULA | ||||||||
State: | MT | ||||||||
PostalCode: | 598047420 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4067284292 | ||||||||
FaxNumber: | 4067285770 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/08/2008 | ||||||||
LastUpdateDate: | 05/25/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RAUCH | ||||||||
AuthorizedOfficialFirstName: | KRISTIN | ||||||||
AuthorizedOfficialMiddleName: | A | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 4067284292 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 6338 | MT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
ID | Type | State | Issuer | Description | 000096350 | 01 | MT | BCBS OF MT | OTHER | 0100711 | 05 | MT |   | MEDICAID |