Healthcare Provider Details

I. General information

NPI: 1255598991
Provider Name (Legal Business Name): MONTANA CANCER SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WESTWOOD DR
HAMILTON MT
59840-2345
US

IV. Provider business mailing address

PO BOX 7877
MISSOULA MT
59807-7877
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-2539
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTY BECKNELSON
Title or Position: MANAGER
Credential:
Phone: 406-728-2539