Healthcare Provider Details

I. General information

NPI: 1063422590
Provider Name (Legal Business Name): MONTANA AUDIOLOGY AND BALANCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 9TH ST S
GREAT FALLS MT
59405-4402
US

IV. Provider business mailing address

1102 9TH ST S
GREAT FALLS MT
59405-4402
US

V. Phone/Fax

Practice location:
  • Phone: 406-727-3115
  • Fax: 406-727-4484
Mailing address:
  • Phone: 406-727-3115
  • Fax: 406-727-4484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: PAM K LOCKE
Title or Position: BOOKKEEPER
Credential:
Phone: 406-727-3115