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General NPI Number Information
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NPI Number | 1164616504
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Entity Type | Organization
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Legal Business Name | PEDIATRIC CARDIOLOGY OF BILLINGS PC
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 1232 N 30TH ST SUITE 300
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City | BILLINGS
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State | MT
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Zip | 59101-0139
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Country | US
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Telephone | 406-238-6190
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Fax | 406-238-6199
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Provider Business Mailing Address
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Address Line | 1232 N 30TH ST SUITE 300
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City | BILLINGS
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State | MT
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Zip | 59101-0139
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Country | US
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Telephone | 406-238-6190
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Fax | 406-238-6199
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Authorized Official
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Title or Position | PHYSICIAN/PRESIDENT
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Name | DR. JAMES WISE WIGGINS JR.
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Credential | M.D.
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Telephone | 406-238-6190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 5109
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License Number State | MT
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