Healthcare Provider Details

I. General information

NPI: 1003216409
Provider Name (Legal Business Name): MONTANA NEUROLOGY & SLEEP MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 N LAST CHANCE GULCH SUITE G2
HELENA MT
59601-4159
US

IV. Provider business mailing address

121 N LAST CHANCE GULCH SUITE G2
HELENA MT
59601-4159
US

V. Phone/Fax

Practice location:
  • Phone: 406-431-1384
  • Fax:
Mailing address:
  • Phone: 406-431-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number10628
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number10628
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number10628
License Number StateMT

VIII. Authorized Official

Name: DR. THOMAS DAVID MULGREW
Title or Position: PRESIDENT
Credential: MD
Phone: 406-431-1384