MEDICARE: VA MONTANA HEALTHCARE SYSTEMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	286500000X	Military Hospital	1106	MT

General Provider Information

NPI Number	:	1457546384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VA MONTANA HEALTHCARE SYSTEMS

Provider Business Mailing Address
First Line	:	PO BOX 1500
Second Line	:
City	:	FORT HARRISON
State	:	MT
Zip	:	59636-1500
Country	:	US
Telephone Number	:	406-447-7599
Fax Number	:

Provider Business Practice Location Address
First Line	:	1892 VETERAN'S WAY
Second Line	:
City	:	FORT HARRISON
State	:	MT
Zip	:	59636-1500
Country	:	US
Telephone Number	:	406-447-7599
Fax Number	:

Authorized Official
Title or Position	:	ADDITION THERAPIST
Name	:	MS. JOAN RENEE SANCHEZ
Credential	:	LAC
Telephone Number	:	406-447-7599

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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