Healthcare Provider Details

I. General information

NPI: 1841055399
Provider Name (Legal Business Name): MONTANA KIDNEY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3550 MULLAN RD STE 103A
MISSOULA MT
59808-5168
US

IV. Provider business mailing address

PO BOX 18032
MISSOULA MT
59808-8032
US

V. Phone/Fax

Practice location:
  • Phone: 406-213-8939
  • Fax: 406-224-6127
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN LAWSON
Title or Position: OWNER
Credential:
Phone: 406-213-8939