=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255879615
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTERN HEALTH SCREENING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2017
-----------------------------------------------------
Last Update Date | 02/06/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 235 MOORE LN SUITE 120
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59101-3446
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-252-3225
-----------------------------------------------------
Fax | 406-259-9579
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 30157
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59107-0157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-252-3225
-----------------------------------------------------
Fax | 406-259-9579
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MARJORIE M HALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-252-3225
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QC1800X
-----------------------------------------------------
Taxonomy Name | Corporate Health Clinic/Center
-----------------------------------------------------
License Number | OL-14-22288
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------