Healthcare Provider Details

I. General information

NPI: 1992465892
Provider Name (Legal Business Name): MONTANA MOBILE HEALTH, CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 HOLT DR UNIT 1082
BIGFORK MT
59911-3044
US

IV. Provider business mailing address

PO BOX 1082
BIGFORK MT
59911-1082
US

V. Phone/Fax

Practice location:
  • Phone: 406-426-2800
  • Fax:
Mailing address:
  • Phone: 406-426-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHERINE BORGES
Title or Position: CEO, PRESIDENT
Credential: MS, FNP, PNP
Phone: 406-426-2800