Healthcare Provider Details

I. General information

NPI: 1508028895
Provider Name (Legal Business Name): ATHENA JANE OCAMPO HALOL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 12/17/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 E MAIN ST
CUT BANK MT
59427-3015
US

IV. Provider business mailing address

519 E MAIN ST
CUT BANK MT
59427-3015
US

V. Phone/Fax

Practice location:
  • Phone: 406-873-5670
  • Fax: 406-873-5675
Mailing address:
  • Phone: 406-873-5670
  • Fax: 406-873-5675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12475
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: