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General NPI Number Information
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NPI Number | 1144382813
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Entity Type | Organization
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Legal Business Name | THE MONTANA HEALTHY WEIGHT MANAGEMENT AND WELLNESS CENTER, PC
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2835 FORT MISSOULA RD STE 303
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City | MISSOULA
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State | MT
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Zip | 59804-7424
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Country | US
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Telephone | 406-542-3687
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Fax | 406-327-4475
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Provider Business Mailing Address
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Address Line | 2835 FORT MISSOULA RD STE 303
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City | MISSOULA
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State | MT
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Zip | 59804-7424
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Country | US
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Telephone | 406-542-3687
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Fax | 406-327-4475
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHLEEN T BASKETT
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Credential | M.D.
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Telephone | 406-542-3687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 6260
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License Number State | MT
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