Healthcare Provider Details

I. General information

NPI: 1629090758
Provider Name (Legal Business Name): ALLERGY AND ASTHMA CONSULTANTS OF MONTANA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N 22ND AVE SUITE 1
BOZEMAN MT
59718-2783
US

IV. Provider business mailing address

2055 N 22ND AVE SUITE 1
BOZEMAN MT
59718-2783
US

V. Phone/Fax

Practice location:
  • Phone: 406-582-1111
  • Fax: 406-582-1112
Mailing address:
  • Phone: 406-582-1111
  • Fax: 406-582-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: PAT WANDERER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 406-582-1111