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General NPI Number Information
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NPI Number | 1386153740
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Entity Type | Organization
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Legal Business Name | ST CORPORATION
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 2827 FORT MISSOULA RD
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City | MISSOULA
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State | MT
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Zip | 59804-7408
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Country | US
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Telephone | 406-544-6438
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Fax |
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Provider Business Mailing Address
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Address Line | 244 MANSION HEIGHTS DR
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City | MISSOULA
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State | MT
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Zip | 59803-2472
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Country | US
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Telephone | 406-544-6438
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. STEPHEN A. TAHTA
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Credential | MD, MBA
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Telephone | 406-544-6438
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 8664
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License Number State | MT
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