Healthcare Provider Details

I. General information

NPI: 1114221983
Provider Name (Legal Business Name): MA CRITICAL CARE SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2011
Last Update Date: 01/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 STOCKYARD RD STE I-200
MISSOULA MT
59808-1548
US

IV. Provider business mailing address

PO BOX 17527
MISSOULA MT
59808-7527
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-8420
  • Fax: 406-541-8430
Mailing address:
  • Phone: 406-728-8420
  • Fax: 406-541-8430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: BARB GILLETT BRETZ
Title or Position: CFO
Credential:
Phone: 406-728-8420