Basic Information
Provider Information
NPI: 1861831356
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHURTZ
FirstName: JOSEPH
MiddleName: C
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2827 FORT MISSOULA RD
Address2:  
City: MISSOULA
State: MT
PostalCode: 598047408
CountryCode: US
TelephoneNumber: 4067284100
FaxNumber:  
Practice Location
Address1: 2827 FORT MISSOULA RD
Address2:  
City: MISSOULA
State: MT
PostalCode: 598047408
CountryCode: US
TelephoneNumber: 4067284100
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/18/2013
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000XMED-PHYS-LIC-57907MTY Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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