Healthcare Provider Details

I. General information

NPI: 1922007202
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF GREAT FALLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 15TH AVE S SUITE 109
GREAT FALLS MT
59405-4334
US

IV. Provider business mailing address

401 15TH AVE S SUITE 109
GREAT FALLS MT
59405-4334
US

V. Phone/Fax

Practice location:
  • Phone: 406-727-6311
  • Fax: 406-727-1070
Mailing address:
  • Phone: 406-727-6311
  • Fax: 406-727-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number4764,5327,8985,9832
License Number StateMT

VIII. Authorized Official

Name: BRENT S WEBER
Title or Position: ADMINISTRATOR
Credential:
Phone: 406-727-6311