Healthcare Provider Details

I. General information

NPI: 1932217114
Provider Name (Legal Business Name): RAVALLI ORTHOPEDICS & SPORTS MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 FAIR GROUNDS ROAD
HAMILTON MT
59840
US

IV. Provider business mailing address

312 FAIR GROUNDS ROAD
HAMILTON MT
59840
US

V. Phone/Fax

Practice location:
  • Phone: 406-361-7680
  • Fax: 406-363-4060
Mailing address:
  • Phone: 406-361-7680
  • Fax: 406-363-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number8555
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0292
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateMT

VIII. Authorized Official

Name: GREGORY M BEHM
Title or Position: PRESIDENT DIRECTOR
Credential: MD
Phone: 406-363-2391