Healthcare Provider Details

I. General information

NPI: 1730189432
Provider Name (Legal Business Name): KISMET MILS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2005
Last Update Date: 05/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WILSON ST
MILES CITY MT
59301
US

IV. Provider business mailing address

2300 WILSON ST
MILES CITY MT
59301-5078
US

V. Phone/Fax

Practice location:
  • Phone: 406-874-2687
  • Fax:
Mailing address:
  • Phone: 406-874-2687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number9760
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number13520
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4672
License Number StateMT

VIII. Authorized Official

Name: MICHAEL L. MOORE
Title or Position: CFO
Credential:
Phone: 605-642-7736