Healthcare Provider Details

I. General information

NPI: 1225385966
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF MONTANA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MOUNTAIN SPRINGS RD
HELENA MT
59602-8433
US

IV. Provider business mailing address

601 MOUNTAIN SPRINGS RD
HELENA MT
59602-8433
US

V. Phone/Fax

Practice location:
  • Phone: 908-625-7887
  • Fax:
Mailing address:
  • Phone: 908-625-7887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01375700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number25MA08851700
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number26NO07865600
License Number StateNJ

VIII. Authorized Official

Name: ERIC DAVID THOMAS
Title or Position: MANAGING DIRECTOR
Credential: M.D.
Phone: 908-625-7887