Healthcare Provider Details

I. General information

NPI: 1861853822
Provider Name (Legal Business Name): EVAN KENT ROMRELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 N 30TH ST
BILLINGS MT
59101-0127
US

IV. Provider business mailing address

1233 N 30TH ST
BILLINGS MT
59101-0127
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-3850
  • Fax: 406-237-3855
Mailing address:
  • Phone: 406-237-3850
  • Fax: 406-237-3855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number87360
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number87360
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: