Healthcare Provider Details

I. General information

NPI: 1376876094
Provider Name (Legal Business Name): THE ORTHOPEDIC CENTER OF MONTANA AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2009
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 25TH ST S
GREAT FALLS MT
59405
US

IV. Provider business mailing address

1401 25TH ST S
GREAT FALLS MT
59405
US

V. Phone/Fax

Practice location:
  • Phone: 406-455-3650
  • Fax: 406-455-3695
Mailing address:
  • Phone: 406-455-3650
  • Fax: 406-455-3695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL A DUBE
Title or Position: ASC/PRESIDENT
Credential: M.D.
Phone: 406-455-3692