Healthcare Provider Details

I. General information

NPI: 1376154039
Provider Name (Legal Business Name): MONTANA SPINAL SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 03/21/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BILLINGS CLINIC, BOZEMAN 3905 WELLNESS WAY
BOZEMAN MT
59718
US

IV. Provider business mailing address

BILLINGS CLINIC, BOZEMAN 3905 WELLNESS WAY
BOZEMAN MT
59718
US

V. Phone/Fax

Practice location:
  • Phone: 406-533-9688
  • Fax: 469-898-1659
Mailing address:
  • Phone: 406-533-9688
  • Fax: 469-898-1659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY J RUSSO
Title or Position: DELEGATED OFFICIAL
Credential: MD
Phone: 406-533-9688