Basic Information
| Provider Information | |||||||||
| NPI: | 1972596880 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTANA PEDIATRIC CRITICAL CARE, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3006 S MARYLAND PKWY | ||||||||
| Address2: | 505 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891092218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026970082 | ||||||||
| FaxNumber: | 7023695827 | ||||||||
| Practice Location | |||||||||
| Address1: | 1233 N 30TH ST | ||||||||
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| City: | BILLINGS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 591010127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883502911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2005 | ||||||||
| LastUpdateDate: | 05/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | SWIFT | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7026970082 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0203X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
No ID Information.