Healthcare Provider Details

I. General information

NPI: 1366778060
Provider Name (Legal Business Name): ANTHONY JAMES SABOL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 TIMBERWOLF PKWY
KALISPELL MT
59901-1218
US

IV. Provider business mailing address

175 TIMBERWOLF PKWY
KALISPELL MT
59901-1218
US

V. Phone/Fax

Practice location:
  • Phone: 406-257-2020
  • Fax: 406-257-5554
Mailing address:
  • Phone: 406-257-2020
  • Fax: 406-257-5554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number160978
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN0000014412
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: