Healthcare Provider Details

I. General information

NPI: 1114098837
Provider Name (Legal Business Name): BADLANDS MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

332 LEAVITT AVE
JORDAN MT
59337
US

IV. Provider business mailing address

PO BOX 443
JORDAN MT
59337-0443
US

V. Phone/Fax

Practice location:
  • Phone: 406-557-2819
  • Fax:
Mailing address:
  • Phone: 406-557-2819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: PAULA MUNIAK
Title or Position: VICE PRESIDENT
Credential:
Phone: 406-557-2819