Healthcare Provider Details

I. General information

NPI: 1639091671
Provider Name (Legal Business Name): MOOSE MEDICAL MANAGEMENT OF MONTANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3572 HESPER RD
BILLINGS MT
59102-6891
US

IV. Provider business mailing address

PO BOX 22541
BILLINGS MT
59104-2541
US

V. Phone/Fax

Practice location:
  • Phone: 406-413-6200
  • Fax:
Mailing address:
  • Phone: 406-413-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL JOSEPH MUSSER
Title or Position: AUTHORIZED OFFICIAL
Credential: MD
Phone: 406-413-6200