Healthcare Provider Details

I. General information

NPI: 1083264816
Provider Name (Legal Business Name): MONTANA STATE UNIVERSITY - BILLINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 UNIVERSITY DR
BILLINGS MT
59101-0245
US

IV. Provider business mailing address

5050 SPRING VALLEY RD
DALLAS TX
75244-3995
US

V. Phone/Fax

Practice location:
  • Phone: 406-657-2369
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTA LEA MONTAGUE
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 406-657-2061