MEDICARE: MASSAJ MAHAL

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	174400000X	Specialist	1062	MT

General Provider Information

NPI Number	:	1730550807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MASSAJ MAHAL

Provider Business Mailing Address
First Line	:	PO BOX 7923
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59904-0923
Country	:	US
Telephone Number	:	406-755-6002
Fax Number	:	888-350-5332

Provider Business Practice Location Address
First Line	:	22 2ND AVE W
Second Line	:	1100
City	:	KALISPELL
State	:	MT
Zip	:	59901-4466
Country	:	US
Telephone Number	:	406-755-6002
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUSAN ERICKSON
Credential	:	LMT, BLS, BS
Telephone Number	:	406-755-6002

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	10/14/2015

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Directions to “MASSAJ MAHAL ” Practice Location

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