Healthcare Provider Details

I. General information

NPI: 1124013354
Provider Name (Legal Business Name): COMMUNITY SURGICAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 FORT MISSOULA RD SUITE 104
MISSOULA MT
59804-7419
US

IV. Provider business mailing address

2831 FORT MISSOULA RD SUITE 104
MISSOULA MT
59804-7419
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-0285
  • Fax: 406-728-0613
Mailing address:
  • Phone: 406-728-0285
  • Fax: 406-728-0613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number7987
License Number StateMT

VIII. Authorized Official

Name: DR. TIMOTHY BRADFORD RICHARDS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 406-728-0285