Healthcare Provider Details

I. General information

NPI: 1154460434
Provider Name (Legal Business Name): UNIVERSITY OF MONTANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SW HIGGINS AVE., SUITE 250
MISSOULA MT
59803-3602
US

IV. Provider business mailing address

700 SW HIGGINS AVE., SUITE 250
MISSOULA MT
59803-3602
US

V. Phone/Fax

Practice location:
  • Phone: 406-243-5769
  • Fax: 406-243-4730
Mailing address:
  • Phone: 406-243-5769
  • Fax: 406-243-4730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MARTIN E. BLAIR
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 406-243-4779