Healthcare Provider Details

I. General information

NPI: 1194910430
Provider Name (Legal Business Name): MOSAIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 W MAIN ST SUITE 218
BELGRADE MT
59714-3700
US

IV. Provider business mailing address

11 W MAIN ST SUITE 218
BELGRADE MT
59714-3700
US

V. Phone/Fax

Practice location:
  • Phone: 406-388-4988
  • Fax: 406-388-6188
Mailing address:
  • Phone: 406-388-4988
  • Fax: 406-388-6188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number9393
License Number StateMT

VIII. Authorized Official

Name: MRS. HEIDI THOMAS
Title or Position: PRESIDENT
Credential: DPT
Phone: 406-388-4988