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General NPI Number Information
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NPI Number | 1205885142
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Entity Type | Organization
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Legal Business Name | MISSOULA SLEEP MEDICINE, LLC
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 01/12/2010
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Provider Practice Location Address
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Address Line | 910 BROOKS ST SUITE 201
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City | MISSOULA
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State | MT
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Zip | 59801-5783
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Country | US
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Telephone | 406-829-8053
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Fax | 406-541-8062
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Provider Business Mailing Address
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Address Line | 910 BROOKS ST SUITE 201
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City | MISSOULA
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State | MT
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Zip | 59801-5783
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Country | US
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Telephone | 406-829-8053
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Fax | 406-541-8062
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Authorized Official
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Title or Position | MEMBER
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Name | RICK B WALL
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Credential |
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Telephone | 406-829-8053
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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 | C108330
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License Number State | MT
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