Healthcare Provider Details

I. General information

NPI: 1306857917
Provider Name (Legal Business Name): ROCKY MOUNTAIN EAR NOSE & THROAT CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WEST KENT
MISSOULA MT
59801-7000
US

IV. Provider business mailing address

700 WEST KENT
MISSOULA MT
59801
US

V. Phone/Fax

Practice location:
  • Phone: 406-541-3277
  • Fax: 406-541-3950
Mailing address:
  • Phone: 406-541-3277
  • Fax: 406-541-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY BROE, CPC, CPPM, OCS
Title or Position: BILLING DIRECTOR
Credential:
Phone: 406-541-3806