=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053778035
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. DAVID H HAMMERMEISTER SR.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2016
-----------------------------------------------------
Last Update Date | 01/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 695 RISING SUN LN
-----------------------------------------------------
City | STEVENSVILLE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59870-6367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-209-4510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 695 RISING SUN LN
-----------------------------------------------------
City | STEVENSVILLE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59870-6367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-209-4510
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 344600000X
-----------------------------------------------------
Taxonomy Name | Taxi
-----------------------------------------------------
License Number | PSC9505
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------