Healthcare Provider Details

I. General information

NPI: 1922008077
Provider Name (Legal Business Name): NORTHERN ROCKIES ORTHOPAEDICS, PLLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 SOUTH AVENUE WEST SUITE 101
MISSOULA MT
59804-5114
US

IV. Provider business mailing address

2740 SOUTH AVE W STE 101
MISSOULA MT
59804-5137
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-6101
  • Fax: 406-721-3278
Mailing address:
  • Phone: 406-728-6101
  • Fax: 406-721-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN A JACOBSON
Title or Position: PARTNER
Credential: MD
Phone: 406-728-6101