Healthcare Provider Details

I. General information

NPI: 1336696152
Provider Name (Legal Business Name): CMSC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2016
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3010 15TH AVE S
GREAT FALLS MT
59405-5240
US

IV. Provider business mailing address

PO BOX 912984
DENVER CO
80291-2984
US

V. Phone/Fax

Practice location:
  • Phone: 406-216-8000
  • Fax: 303-306-7753
Mailing address:
  • Phone: 303-306-7783
  • Fax: 303-306-7753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number12794
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number12794
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number12794
License Number StateMT
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number12794
License Number StateMT

VIII. Authorized Official

Name: VICKI LEE NEWMILLER
Title or Position: COO
Credential:
Phone: 406-216-8000