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General NPI Number Information
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NPI Number | 1114050481
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Entity Type | Organization
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Legal Business Name | MOUNTAIN MOBILE WOUND CARE
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 1801 SELWAY DR
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City | MISSOULA
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State | MT
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Zip | 59808-9314
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Country | US
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Telephone | 406-240-4593
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 SELWAY DR
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City | MISSOULA
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State | MT
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Zip | 59808-9314
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Country | US
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Telephone | 406-240-4593
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Fax |
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Authorized Official
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Title or Position | PRES.
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Name | DR. JOHN KEVIN BEIGHLE
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Credential | FNP, DPM
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Telephone | 406-240-4593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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