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General NPI Number Information
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NPI Number | 1447207212
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Entity Type | Organization
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Legal Business Name | MISSOULA BONE & JOINT, LLC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 2360 MULLAN RD SUITE C
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City | MISSOULA
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State | MT
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Zip | 59808-1811
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Country | US
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Telephone | 406-721-4436
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Fax | 406-721-6053
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Provider Business Mailing Address
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Address Line | 2360 MULLAN RD SUITE C
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City | MISSOULA
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State | MT
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Zip | 59808-1811
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Country | US
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Telephone | 406-721-4436
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Fax | 406-721-6053
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. SAMANTHA SPENCER
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Credential | CEO
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Telephone | 406-721-4436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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